Logo image
Back
Flecainide: Steady state electrophysiologic effects in patients with remote myocardial infarction and inducible sustained ventricular arrhythmia
Journal article   Open access   Peer reviewed

Flecainide: Steady state electrophysiologic effects in patients with remote myocardial infarction and inducible sustained ventricular arrhythmia

Charles R. Webb, Joel Morganroth, Sheila Senior, Scott R. Spielman, Allan M. Greenspan and Leonard N. Horowitz
Journal of the American College of Cardiology, v 8(1), pp 214-220
Jul 1986
DOI: https://doi.org/10.1016/S0735-1097(86)80115-2
PMID: 3711519
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/s0735-1097(86)80115-2View
Published, Version of Record (VoR) Open

Abstract

The effect of flecainide in 24 patients with inducible sustained ventricular arrhythmia and a history of remote myocardial infarction was determined. Flecainide was administered in oral doses individually adjusted to suppress all spontaneous ventricular tachycardia and 80% of ventricular premature complexes on 24 hour ambulatory (Holter) electrocardiography. Antiarrhythmic therapy, as assessed by Hotter monitoring, was adequate in 20 (83%) of the study patients at a mean dose of 144 ± 28 mg every 12 hours; the mean plasma flecainide level was 583 ± 329 ng/ml. In 18 patients, the mean sinus cycle length, sinus node recovery time and atrial, atrioventricular nodal and ventricular refractory periods were unchanged. The AH interval increased by 15 ±15%, the HV interval by 35 ± 32% and the QRS duration by 24 ± 21%. Toxicity or failure to suppress ventricular premature complexes and ventricular tachycardia by Holter monitoring precluded electrophysiologic study with flecainide in four patients; two patients refused electrophysiologic study with flecainide for nonmedical reasons. Ventricular tachycardia was not inducible in 4 (22%) of 18 patients receiving flecainide. Sustained arrhythmia remained inducible in 14 patients (78%) despite evidence of antiarrhythmic efficacy on Holter monitoring, but the rate of the induced ventricular tachycardia was slower and symptoms were alleviated during ventricular tachycardia in 10 (56%) of 18 patients. The 4 patients who had no inducible ventricular tachycardia with flecainide, and the 10 patients who had inducible ventricular tachycardia with a longer cycle length and alleviation of their symptoms, have been followed up as outpatients for 16 ± 7 months. No death or spontaneous arrhythmic event has occurred among the four patients with no inducible arrhythmia. Ventricular tachycardia has occurred in 4 of 10 and sudden cardiac death in 1 of 10 patients whose tachycardia remained inducible with flecainide. Thus, even after optimal flecainide dosing by Holter monitoring criteria, electrophysiologic assessment of drug efficacy provides for additional risk stratification.

Metrics

3 Record Views
18 citations in Web of Science
15 citations in Scopus

Details

UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

InCites Highlights

Data related to this publication, from InCites Benchmarking & Analytics tool:

Web of Science research areas
Cardiac & Cardiovascular Systems
Logo image