Why the study?
Does flecainide acetate increase selective His-bundle capture threshold in patients with permanent His-bundle pacemakers?
Does flecainide acetate increase selective His-bundle capture threshold in patients with permanent His-bundle pacemakers?
Flecainide acetate may cause a marked, reversible rise in selective His-bundle capture thresholds, potentially mimicking lead failure and decreasing battery longevity.
May warrant threshold monitoring with flecainide in His-bundle pacing; hypothesis-generating for reversible drug effects on capture.
A 64-year-old man underwent implantation of a permanent His-bundle pacemaker. A marked rise in the selective His-bundle capture threshold was noted 1 month after the patient started flecainide acetate for rhythm control of recurrent, symptomatic atrial flutter and atrial fibrillation. The capture threshold subsequently normalized 4 days after discontinuing flecainide and switching to dofetilide. To our knowledge, this is the first documented case of a rise in selective His-bundle capture threshold associated with flecainide acetate. Further studies are needed to characterize this association which could result in higher capture thresholds, decreased battery longevity, and mimic His-bundle lead failure.
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Jiang et al. (2020) studied this question.
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