Encainide: a new antiarrhythmic agent

Encainide is classified as a type Ic antiarrhythmic agent. Absorption is essentially complete, but bioavailability is variable because of first-pass metabolism. Two metabolic phenotypes, extensive and poor metabolizers, have been identified. O-demethyl encainide and 3-methoxy-O-demethyl encainide are active metabolites of encainide and contribute significantly to its antiarrhythmic effect. In clinical trials, encainide has been shown to be highly effective in suppressing premature ventricular contractions and ventricular tachyarrhythmias. The drug is useful in treating ventricular arrhythmias refractory to other agents. Encainide is also moderately effective in supraventricular arrhythmias involving an accessory pathway. It is highly effective in cases of Wolff-Parkinson-White syndrome, where the accessory pathway has a short refractory period. Common adverse effects of encainide are dizziness, visual disturbances, nausea, and headache. Encainide appears to be a safe and effective antiarrhythmic agent with few adverse effects and negligible hemodynamic effects. Encainide may be a useful agent for ventricular and supraventricular arrhythmias, particularly those refractory to other agents.