Flecainide usage should be restricted to cardiologists alone. Flecainide should always be co-administered with a rate control agent e.g. beta-blocker
- CAST study published in 1989 in the NEJM looked at the use of Flecainide and other Ic agents in patients with IHD post-MI and with LV dysfunction and ventricular ectopics and found that far from preventing deaths it increased the number of arrhythmia-related deaths
Mode of action
- Flecainide inhibits fast sodium channels but does not widens the action potential duration and so is a Class Ic drug.
- It does prolong the QT and can cause arrhythmias.
- Slows conduction through the whole conduction path from atria to ventricle
- Treatment/prevention of AFib/Flutter and SVT
- WPW syndrome with accessory bundle related arrhythmias
- Arrhythmia prevention: Flecainide 100 mg BD (200 mg/day)
- Pill in the pocket dose for AF is Flecainide 300 mg stat PO
- Acute: Flecainide 2 mg /kg (max 150 mg) IV over 30 minutes if no structural or coronary heart disease.
Dose range: Get Echo if concerns over structural heart disease
|Flecainide (Fast AF)|| 2 mg/kg (max 150 mg)||stat||Slow IV Infusion over 30-60 minutes|
|Flecainide (long term) ||100 mg||BD||PO|
|Flecainide (fast AF "pill in pocket") ||300 mg||stat||PO|
- Avoid in Atrial flutter as can cause 1:1 conduction and worsening tachycardia
- Not to be used on those with structural heart disease ie. LV dysfunction
- Ischaemic heart disease or 2nd/3rd-degree heart block, Cardiogenic shock
- Dizziness, Palpitations, Chest pain, Dyspnoea, Visual disturbance
- Ataxia and taste disturbance at high doses, Ventricular tachycardia
- Patients should have serial ECGs to monitor PR interval and ORS duration.
- Patients with pacemakers or AICDs should be discussed with cardiology prior to the administration of Flecainide as this drug may affect the devices ability to deliver therapy adequately.