Experience with flecainide for the treatment of cardiac arrhythmias in children
K A Priestley1, E J Ladusans, E Rosenthal
1Department of Cardiology, Guy's Hospital, London, U.K.
Insights
Flecainide effectively controlled arrhythmias in 59% of pediatric patients, including those with prior treatment failures. Lower flecainide concentrations were associated with successful arrhythmia control in children.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
Background:
- Flecainide is a Class I antiarrhythmic agent.
- Pediatric arrhythmias require effective treatment options, especially when conventional therapies fail.
Purpose of the Study:
- To evaluate the efficacy and safety of flecainide in pediatric patients with various arrhythmias.
- To assess flecainide's role in cases of treatment-resistant arrhythmias.
Main Methods:
- Retrospective analysis of 22 children (3 days to 16 years 6 months) treated with flecainide.
- Treatment included various arrhythmias like atrioventricular tachycardia, atrial arrhythmias, and ventricular tachycardia.
- Follow-up duration ranged from 3-24 months with assessment of arrhythmia control and flecainide concentrations.
Main Results:
- Arrhythmia control was achieved in 13 out of 22 children (59%) during a median 12-month follow-up.
- Sinus rhythm was restored in all four children treated during an active tachycardia episode.
- Lower median pre-dose flecainide concentrations (225 µg/L) were observed in responders compared to non-responders (417 µg/L).
- One case of an arrhythmogenic effect was reported.
Conclusions:
- Flecainide is an effective treatment for various pediatric arrhythmias, particularly in cases refractory to other antiarrhythmic drugs.
- Therapeutic drug monitoring may be beneficial, as lower flecainide concentrations correlated with treatment success.
- Flecainide demonstrated a favorable safety profile in this pediatric cohort, with one arrhythmogenic event.
Abstract:
We treated 22 children, aged 3 days to 16 years 6 months (median 11 years 1 month), with flecainide for a variety of arrhythmias where a Class I agent was indicated. In 16, conventional antiarrhythmic treatment had failed. Structural heart disease was present in nine. The arrhythmia was paroxysmal re-entry atrioventricular tachycardia in nine; paroxysmal atrial tachycardia, flutter or fibrillation in five; paroxysmal ventricular tachycardia in five and frequent ventricular extrasystoles (with couplets) in three. Sinus rhythm was achieved in all four children who received flecainide during tachycardia (three received intravenous flecainide, one oral). During follow-up of 3-24 months (median 12 months), arrhythmia control was obtained in 13 children (59%). Combination therapy was used in seven of these; with digoxin in four and a beta blocker in three. Flecainide doses used in this study ranged from 1-11 mg kg-1 day-1 (median 4 mg kg-1 day-1), 25-297 mg m-2 day-1 (median 113 mg m-2 day-1). The median, pre-dose flecainide concentration in those responding to therapy was 225 micrograms l-1 and in those failing to respond was 417 micrograms l-1. An arrhythmogenic effect occurred in one child.
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