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Flecainide-Induced Atrial Flutter With 1:1 Conduction Complicated by Ventricular Fibrillation After Electrical
Timothy Colangelo1, Drew Johnson2, Reginald Ho2
1Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
Texas Heart Institute Journal
|June 4, 2021
Summary
Flecainide can rarely cause rapid atrial flutter, leading to ventricular fibrillation. This case highlights the proarrhythmic risks of flecainide and the need for careful patient management.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Flecainide is a Class IC antiarrhythmic drug commonly used for atrial arrhythmias.
- Atrial fibrillation management can involve flecainide maintenance therapy.
Observation:
- A 59-year-old male on flecainide for refractory atrial fibrillation developed 1:1 atrial flutter with rapid conduction.
- Synchronized cardioversion attempt by emergency medical technicians resulted in ventricular fibrillation, requiring defibrillation.
Findings:
- Flecainide can induce atrial proarrhythmic effects, including 1:1 atrial flutter.
- Rapid ventricular response during atrial flutter can precipitate life-threatening arrhythmias like ventricular fibrillation.
Implications:
- This case underscores the importance of recognizing and managing flecainide-induced proarrhythmias.
- Radiofrequency ablation and cryoablation were effective in resolving symptomatic atrial flutter in this high-risk patient.
- Mitigation strategies are crucial for high-risk patients on flecainide to prevent adverse cardiac events.
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