Fulminant flecainide intoxication in an adolescent: cardiogenic shock requiring VA-ECMO support

Figures

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  Figure 1. ECG on admission revealing prolonged PR interval (200 ms) and QRS widening (~140 ms), indicative of trifascicular block in the adolescent patient.

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  Figure 2. ECG 2 hours from admission during acute deterioration showing severe QRS widening (~200 ms), left bundle branch morphology and absence of P waves, reflecting profound conduction impairment.

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  Figure 3. Coronary angiography confirming the absence of obstructive coronary artery disease during evaluation for acute cardiogenic shock.

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  Figure 4. ECG 24 hours from admission depicting episodes of sustained ventricular tachycardia during early veno-arterial extracorporeal membrane oxygenation support, managed with cardioversion.

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  Figure 5. ECG 48 hours from admission showing restoration of sinus rhythm with shortening of QRS duration and persistent QT prolongation during initial recovery.

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  Figure 6. ECG on discharge displaying normalisation of QRS and QT intervals, with residual T-wave inversions.

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  Figure 7. Timeline of clinical parameters, interventions and outcome Comprehensive timeline illustrating key clinical events, haemodynamic changes and therapeutic interventions throughout hospitalisation. ECMO, extracorporeal membrane oxygenation; MAP, mean arterial pressure.