Is flecainide used as a rescue medication?

From the Guidelines

Flecainide can be used as a rescue medication in certain cases, specifically for patients with paroxysmal atrial fibrillation who are otherwise healthy and have been evaluated for safety with this strategy, as part of a "pill-in-the-pocket" approach. This approach is based on the evidence from the 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation, which suggests that class IC drugs like flecainide may be initiated on an outpatient basis for selected patients with lone AF without structural heart disease 1. The key considerations for using flecainide as a rescue medication include:

• The patient should have paroxysmal atrial fibrillation with infrequent episodes
• The patient should be otherwise healthy, without structural heart disease or ischemic heart disease
• The patient should have been evaluated for safety with this strategy by a cardiologist
• A beta blocker or nondihydropyridine calcium channel antagonist should be given at least 30 min before administration of flecainide to prevent rapid AV conduction in the event of atrial flutter
• The patient should be monitored for potential proarrhythmic effects, including torsades de pointes, sustained monomorphic ventricular tachycardia, and atrial proarrhythmia. It is essential to note that flecainide is a prescription medication that requires careful selection and monitoring by a cardiologist, and its use as a rescue medication should be individualized based on the patient's specific condition and medical history.

From the Research

Flecainide as a Rescue Medication

• Flecainide is used as a rescue medication in certain situations, such as the "pill-in-the-pocket" approach for patients with atrial fibrillation (AF) 2.
• This approach involves the self-administration of a single oral loading dose of flecainide to terminate recent-onset AF outside of the hospital setting 2.
• Studies have shown that flecainide is effective in converting AF to sinus rhythm in a significant proportion of patients, with a low incidence of adverse effects 3, 2.
• However, caution is required when using flecainide as a rescue medication, particularly in patients with structural heart disease or elevated cardiovascular risk 3.
• The safety and efficacy of flecainide as a rescue medication can be improved with proper patient selection, monitoring, and education 4, 2.

Specific Uses of Flecainide as a Rescue Medication

• Flecainide can be used as a rescue medication for the cardioversion of recent-onset AF in patients without structural heart disease 4.
• It can also be used for the pretreatment of patients prior to direct current cardioversion 4.
• In addition, flecainide can be used for the ongoing maintenance of sinus rhythm in patients with AF 4.
• The "pill-in-the-pocket" approach with flecainide has been shown to be feasible and safe in a selected population of patients with recurrent AF 2.