Key result
Synchronized cardioversion of flecainide-induced 1:1 atrial flutter triggers ventricular fibrillation in a case report.
Why the study?
Flecainide can rarely cause 1:1 atrial flutter with rapid conduction leading to serious complications, but detailed clinical descriptions are limited.
Case Report (n=1)
This case highlights the rare but severe proarrhythmic risk of flecainide-induced 1:1 atrial flutter and the potential for ventricular fibrillation when synchronized cardioversion is attempted.
May warrant flecainide caution during AF cardioversion; leaves open prospective validation of proarrhythmic risks.
Flecainide, a widely prescribed class IC agent used to treat atrial arrhythmias, can in rare cases cause 1:1 atrial flutter with rapid conduction. We describe the case of a 59-year-old man who was on a maintenance regimen of flecainide for refractory atrial fibrillation. When 1:1 atrial flutter with rapid conduction developed, emergency medical technicians attempted synchronized cardioversion, which caused ventricular fibrillation necessitating defibrillation. The patient ultimately underwent radiofrequency ablation and cryoablation to resolve his symptomatic atrial flutter. We discuss the atrial proarrhythmic effects of flecainide and how to mitigate complications in high-risk patients.
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Colangelo et al. (2021) conducted a case report in Refractory atrial fibrillation (n=1). Flecainide was evaluated. Flecainide maintenance therapy for refractory atrial fibrillation caused 1:1 atrial flutter, which degenerated into ventricular fibrillation upon synchronized cardioversion in a 59-year-old man.
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