From the Guidelines
Flecainide should be used with caution in patients with atrial fibrillation, particularly those with structural heart disease or heart failure, due to its potential to worsen arrhythmias, as indicated by the 2015 ESC guidelines 1.
Key Considerations
- The typical adult dosage of flecainide ranges from 200-400 mg per day, as stated in the 2015 ESC guidelines 1.
- Flecainide works by blocking sodium channels, which helps restore normal heart rhythm, but it can also cause negative inotropic effects, QRS widening, and pro-arrhythmia 1.
- Patients with severe sinus node dysfunction, severe AV conduction disturbances, previous myocardial infarction, CAD, HF, reduced LVEF, or haemodynamically valvular heart disease should avoid flecainide or use it with caution 1.
Monitoring and Precautions
- Regular monitoring of ECG and blood levels is necessary during treatment to ensure safety and effectiveness 1.
- Patients should be alerted to the potential significance of symptoms such as syncope, and warned about the use of non-cardiac drugs that can prolong the QT interval 1.
- Flecainide should be used in combination with other antiarrhythmic drugs, such as beta-blockers or amiodarone, with caution and under close monitoring 1.
Clinical Context
- Flecainide is particularly effective in patients with lone AF, but it should be used as a secondary or tertiary treatment option in patients with vagally induced AF 1.
- In patients with adrenergically mediated AF, beta-blockers represent first-line treatment, followed by sotalol and amiodarone, while flecainide is not the first choice 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Flecainide acetate tablets, USP have local anesthetic activity and belong to the membrane stabilizing (Class 1) group of antiarrhythmic agents; they have electrophysiologic effects characteristic of the IC class of antiarrhythmics Flecainide acetate tablets, USP cause a dose-related and plasma-level related decrease in single and multiple PVCs and can suppress recurrence of ventricular tachycardia Plasma levels above 0. 7 to 1 mcg/mL are associated with a higher rate of cardiac adverse experiences such as conduction defects or bradycardia.
The main use of Flecainide is to suppress recurrence of ventricular tachycardia and decrease PVCs.
- Key effects: dose-related decrease in intracardiac conduction, decrease in ventricular conduction velocity, and increase in sinus node recovery times.
- Therapeutic plasma levels: 0.2 to 1 mcg/mL.
- Adverse effects: conduction defects, bradycardia, and negative inotropic effect 2
From the Research
Flecainide Overview
- Flecainide is a Class Ic antiarrhythmic drug used for rhythm control in patients with atrial fibrillation (AF) 3.
- It works by blocking the cardiac fast inwards Na+ current 3.
- Flecainide is often used in combination with other medications, such as atrioventricular-nodal blocking co-medication 3.
Efficacy and Safety
- Long-term therapy with flecainide has shown clinical efficacy in approximately half of the patients with paroxysmal or persistent AF 3.
- However, flecainide is also associated with a relatively high rate of adverse events, particularly proarrhythmic effects, which often result in therapy discontinuation 3, 4.
- The proarrhythmic risk of flecainide has been ranked as higher than other antiarrhythmic drugs, such as propafenone and sotalol 4.
Comparison with Other Antiarrhythmic Drugs
- Flecainide has been compared to other antiarrhythmic drugs, such as propafenone and sotalol, in terms of efficacy and safety 5, 6, 7.
- Studies have shown that flecainide is more effective than propafenone and sotalol in reducing PVC burden in patients with idiopathic premature ventricular complexes 7.
- However, flecainide has also been shown to have a higher proarrhythmic risk than propafenone and sotalol 4.