From the Guidelines
Flecainide is used to treat paroxysmal supraventricular tachycardia (SVT) in patients without structural heart disease or ischemic heart disease who are not candidates for, or prefer not to undergo, catheter ablation. This recommendation is based on the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1. The guideline suggests that flecainide or propafenone is reasonable for ongoing management in these patients, with a dosage of 100 mg/day to 300 mg/day for flecainide.
When considering the use of flecainide, it is essential to weigh the potential benefits against the risks, particularly the risk of proarrhythmia in patients with structural heart disease or ischemic heart disease 1. Therefore, flecainide should only be prescribed for patients with structurally normal hearts who have recurrent, symptomatic episodes of SVT that significantly impact quality of life.
Key points to consider when prescribing flecainide include:
- Cardiac evaluation, including ECG and possibly echocardiography, to rule out structural heart disease 1
- Starting with a lower dose (50-100 mg twice daily) and gradually increasing as needed based on response and tolerability
- Regular monitoring of ECG and electrolytes during treatment
- Advising patients to report any new symptoms, such as palpitations, dizziness, or syncope, immediately
Overall, flecainide can be an effective treatment option for patients with paroxysmal SVT who meet the specified criteria, and its use should be guided by the latest clinical guidelines and a thorough assessment of the patient's individual needs and risks 1.
From the FDA Drug Label
In patients without structural heart disease, flecainide acetate tablets, USP are indicated for the prevention of: •paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia and other supraventricular tachycardias of unspecified mechanism associated with disabling symptoms Flecainide is used to treat paroxysmal SVT in patients without structural heart disease, specifically for the prevention of episodes associated with disabling symptoms 2.
- The treatment is indicated for patients with paroxysmal supraventricular tachycardias (PSVT), including various types of tachycardias.
- The use of flecainide should be reserved for patients in whom the benefits of treatment outweigh the risks.
From the Research
Flecainide Use in Paroxysmal SVT
Flecainide is used to treat paroxysmal supraventricular tachycardia (SVT) in various patient populations. The following points highlight its use:
- Flecainide is effective in treating paroxysmal SVT in newborns without structural heart disease, with a success rate of 85% in one study 3.
- In patients with supraventricular arrhythmias, including paroxysmal SVT, flecainide has been shown to be safe and effective, with 87% of patients with paroxysmal SVT improving symptomatically 4.
- Flecainide prevents recurrence of symptomatic paroxysmal SVT, with an actuarial 79% freedom from symptomatic PSVT events compared to 15% on placebo at 60 days 5.
- Long-term therapy with flecainide maintains its beneficial response in preventing paroxysmal SVT and paroxysmal atrial fibrillation, with significant increases in the number of patients free of arrhythmic attacks 6.
- Flecainide is also effective in treating patients with AV nodal or AV reentrant SVT, with 9 out of 15 patients having noninducible reentrant SVT after intravenous or oral flecainide therapy 7.
Key Findings
- Flecainide is well-tolerated and effective as first-line treatment for paroxysmal SVT in newborns without structural heart disease 3.
- Flecainide appears to be safe and effective treatment for patients with supraventricular arrhythmias, including paroxysmal SVT 4.
- Flecainide slows symptomatic PSVT heart rates and increases the interval between attacks 5.
- Long-term therapy with flecainide is effective in maintaining its beneficial response in preventing paroxysmal SVT and paroxysmal atrial fibrillation 6.
- Flecainide is an effective and convenient antiarrhythmic agent to treat patients who have AV nodal or AV reentrant SVT 7.