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The Safety and Effectiveness of Flecainide in Children in the Current Era

Taylor Cunningham1, Orhan Uzun1,2, Rachel Morris2

  • 1Children's Heart Centre, British Columbia's Children's Hospital, 1F9, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.

Pediatric Cardiology
|August 26, 2017
PubMed

Insights

Flecainide is a safe and effective antiarrhythmic drug for children, including those with congenital heart disease (CHD). This study found similar safety and effectiveness in children with and without CHD, with low adverse event rates.

Area of Science:

  • Pediatric Cardiology
  • Clinical Pharmacology
  • Cardiac Electrophysiology

Background:

  • Flecainide is an antiarrhythmic medication used in adults.
  • Its safety and efficacy in pediatric populations, particularly those with congenital heart disease (CHD), require further investigation.
  • Existing data on flecainide use in children with CHD is limited.

Purpose of the Study:

  • To evaluate the safety and effectiveness of flecainide in children with normal hearts.
  • To assess flecainide's safety and effectiveness in pediatric patients with congenital heart disease (CHD) or cardiomyopathy (CMO).
  • To compare adverse event rates and treatment outcomes between children with and without CHD.

Main Methods:

  • Retrospective study analyzing data from two pediatric cardiology sites (2000-2015).
  • Included 175 pediatric patients receiving flecainide, with a subgroup of 20 patients having CHD and two with CMO.
  • Compared outcomes, including adverse events and arrhythmia control, between patients with CHD and those with normal hearts.

Main Results:

  • Flecainide was well-tolerated in the overall cohort, with fewer than 3% discontinuing due to adverse events.
  • No significant difference in adverse event incidence was observed between children with normal hearts and those with CHD.
  • Arrhythmia control rates were high in both groups (90% in CHD patients vs. 77% in normal heart patients), with no cardiac arrests during follow-up.

Conclusions:

  • Flecainide is a safe and effective antiarrhythmic treatment for children, including those with underlying CHD.
  • Contrary to some adult studies, flecainide demonstrated comparable safety in pediatric patients with and without CHD.
  • The findings support the use of flecainide in pediatric patients requiring antiarrhythmic therapy, irrespective of underlying cardiac conditions.

Keywords:
Antiarrhythmic medicationCardiomyopathyCongenital heart diseaseFlecainidePediatric electrophysiology

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