Key result
Holding metoprolol during flecainide therapy for AF is linked to wide complex tachycardia.
Why the study?
Class IC antiarrhythmics like flecainide exhibit use dependence that may predispose patients to malignant arrhythmias during tachycardia episodes.
Case Report (n=1)
Highlights the risk of flecainide-induced wide complex tachycardia due to use dependence when AV nodal blocking agents like metoprolol are held.
Caution advised when interrupting AV nodal blockade with flecainide; case reports leave open need for prospective confirmation.
Class IC antiarrhythmics are generally considered a safe means of treating many common arrhythmias such as atrial fibrillation (a-fib), atrial flutter (a-flutter), and paroxysmal supraventricular tachycardia (PSVT). Essentially, flecainide works by binding and blocking sodium channels more effectively at higher heart rates. However, this class of drugs is known to exhibit use dependence which could predispose patients to the development of malignant arrhythmias during episodes of tachycardia. In this case, we present a patient who was being treated with flecainide for a-fib who ultimately developed a wide complex tachycardia after her metoprolol was held.
No takes yet. Share an insight, caveat, or question.
Ezeh et al. (2022) conducted a case report in Atrial fibrillation (n=1). Flecainide was evaluated on Wide complex tachycardia. An elderly female treated with flecainide for atrial fibrillation developed a wide complex tachycardia after her metoprolol was held.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: