From the Guidelines
Flecainide is contraindicated in atrial fibrillation due to the risk of life-threatening ventricular arrhythmias, particularly in patients with significant ischemic heart disease or heart failure 1.
Key Considerations
- Flecainide can convert atrial fibrillation into atrial flutter with 1:1 conduction, resulting in high ventricular rates 1.
- This can be prevented by pre-administering a beta-blocker, verapamil, or diltiazem 1.
- The use of flecainide in atrial fibrillation is generally discouraged, especially in patients with structural heart disease or other underlying cardiac conditions.
Alternative Treatment Options
- Beta blockers, calcium channel blockers, or anti-arrhythmic agents like amiodarone or dofetilide may be considered for rate or rhythm control in atrial fibrillation.
- These alternatives can help mitigate the risks associated with flecainide and provide more effective management of atrial fibrillation.
Important Precautions
- Flecainide and propafenone should only be used in patients without significant ischaemic heart disease or heart failure to avoid the risk of life-threatening ventricular arrhythmias 1.
From the FDA Drug Label
Use of flecainide acetate tablets, USP in chronic atrial fibrillation has not been adequately studied and is not recommended. (See BOXED WARNINGS.)
Flecainide is contraindicated in chronic atrial fibrillation because its use in this condition has not been adequately studied and is not recommended 2.
From the Research
Flecainide Contraindication in Atrial Fibrillation
- Flecainide is contraindicated in patients with atrial fibrillation who have structural heart disease due to a high proarrhythmic risk, as shown in the Cardiac Arrhythmia Suppression Trial study results 3, 4.
- The use of flecainide in patients with atrial fibrillation is recommended only in carefully selected patients without structural heart disease, as stated in current European and North American guidelines 4, 5.
- Flecainide can induce severe cardiogenic shock, even in therapeutic doses, in patients without contraindication, highlighting the need for cautious monitoring after new administration or dose increase 6.
- Long-term treatment with flecainide in patients with atrial fibrillation may be associated with an increased incidence of sudden cardiac death and proarrhythmic events, suggesting that further investigation into its safety is warranted 7.
Key Considerations
- Flecainide is not recommended for patients with structural heart disease due to the risk of proarrhythmia 3, 4.
- Patients without structural heart disease may be eligible for flecainide treatment, but careful selection and monitoring are necessary 4, 5.
- The risk of cardiogenic shock and proarrhythmic events should be considered when prescribing flecainide for atrial fibrillation 6, 7.