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, as stated in the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1. When considering the use of flecainide for paroxysmal SVT, it is essential to weigh the potential benefits against the risks, particularly the risk of proarrhythmia in patients with underlying heart disease.
- The recommended dosage of flecainide for SVT is 100 mg/day to 300 mg/day, as demonstrated in several randomized controlled trials (RCTs) that have shown its efficacy in preventing recurrences of SVT in symptomatic patients 1.
- Flecainide should be reserved for patients who have not responded to or cannot tolerate first-line treatments such as beta-blockers, diltiazem, or verapamil, due to its potential side effects and proarrhythmic risks 1.
- Before initiating flecainide, a thorough cardiac evaluation, including an ECG, should be performed to rule out structural heart disease or ischemic heart disease, as these conditions are contraindications for the use of flecainide 1.
- Regular monitoring of ECG and electrolytes is crucial during treatment with flecainide, and patients should be advised to report any symptoms such as palpitations, dizziness, or shortness of breath immediately 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 appears to be safe and effective for treating patients with supraventricular arrhythmias, including paroxysmal SVT 3.
- In newborns, flecainide can be used as a first-line treatment for paroxysmal SVT, with effective restoration of sinus rhythm and control of SVT in 85% of patients 4.
- Long-term therapy with flecainide maintains its beneficial response in preventing paroxysmal SVT, with significant increases in the number of patients free from arrhythmic attacks 5.
- Flecainide prevents recurrence of symptomatic paroxysmal SVT, with an actuarial 79% freedom from symptomatic PSVT events compared to 15% on placebo at 60 days 6.
- Flecainide is effective in treating patients with AV nodal or AV reentrant SVT, with suppression of SVT in 9 out of 15 patients and prevention of tachycardia recurrence in 7 out of 8 patients whose SVT was suppressed 7.
Patient Populations
Flecainide can be used in various patient populations, including:
- Newborns with paroxysmal SVT without structural heart disease 4.
- Patients with documented symptomatic paroxysmal supraventricular tachycardia (PSVT) 6.
- Patients with AV nodal or AV reentrant SVT 7.
- Patients with supraventricular arrhythmias, including atrial tachycardias, atrial-ventricular tachycardias, paroxysmal atrial fibrillation/flutter, and chronic atrial fibrillation 3.