Amiodarone used in successful resuscitation after near-fatal flecainide overdose

We report the case of a 45-year-old woman who had ingested 2000 mg of flecainide with suicidal intent. She developed therapy-resistant ventricular fibrillation (VF) with cardiopulmonary arrest. Cardiopulmonary resuscitation and advanced life support were sustained for 64 min. Following intravenous amiodarone, the patient developed an effective spontaneous rhythm and resumed breathing. An amiodarone infusion was started and continued over a period of 72 h. She recovered completely after 5 days, leaving the hospital without neurological sequelae. Serum flecainide levels approximately 5 h post-ingestion were 850 mg/l. This case report confirms the value of amiodarone in drug-resistant VF, even when the cause may be another antiarrhythmic drug such as flecainide.