This case highlights that bradycardia-dependent TdP with QT prolongation is a potential mechanism for flecainide-induced proarrhythmia.
May prompt QT/HR monitoring on flecainide; case report leaves open mechanism prevalence and risk stratification.
Although flecainide has a risk of proarrhythmia in patients with structural heart disease, its mechanism has been mainly ascribed to use-dependency and a rapid ventricular response to organized atrial tachyarrhythmias or to ventricular tachycardia. We present a patient who experienced recurrent syncope due to bradycardia-dependent torsade de pointes (TdP) associated with flecainide-related bradycardia and QT prolongation. Bradycardia-dependent TdP with QT prolongation can be considered as one of mechanisms of flecainide-induced proarrhythmia.
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Kim et al. (2010) studied this question.
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