Antiarrhythmic agents and the danger of proarrhythmic events

Article Abstract:

Flecainide is an antiarrhythmic drug used to treat ventricular arrhythmias, or irregular heartbeat. There is recent evidence that treatment of patients who have coronary artery disease, especially those who have recently had a heart attack, with flecainide can cause a highly proarrhythmic effect, or aggravated arrhythmia. The proarrhythmic effects of antiarrhythmic agents have not been well evaluated. Risk factors for this undesirable side effect include poor function of the left ventricle and arrhythmia lasting long periods of time. A recent study by R.H. Falk in the July 15, 1990 issue of the Annals of Internal Medicine presents three patients with atrial fibrillation, abnormally rapid and uncontrolled contractions of the atria of the heart, who were treated with flecainide and developed severe ventricular arrhythmia. The effects of flecainide were increased when the patients with atrial fibrillation exercised vigorously. It is felt that before prescribing treatment with antiarrhythmic drugs, the presence of cardiovascular disease and other factors should be carefully evaluated, including determining whether the benefit of treatment of the arrhythmia is greater than the risk of treatment and the status of the patient, and whether the use of other drugs and the presence of diseased states or abnormal metabolic situations could alter the metabolism and action of the drug. The therapy should be closely monitored. It is necessary to consider these factors to ensure that the medical condition of the patients is not worse after treatment than before. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Flecainide-induced ventricular tachycardia and fibrillation in patients treated for atrial fibrillation

Article Abstract:

Flecainide is an antiarrhythmic drug used to treat ventricular arrhythmias, or irregular heartbeat. It is known that flecainide can cause proarrhythmia, or aggravated arrhythmia, especially among patients whose left ventricles are not functioning properly and those who have had ventricular tachycardia, rapid contractions of the heart. Fourteen patients with atrial fibrillation, abnormally rapid and uncontrolled contractions of the atrium, were treated with flecainide and observed for 12 months. Three of the patients developed severe ventricular arrhythmia. These patients did not have the risk factors which are normally associated with proarrhythmia, structural heart disease or tachycardia. Severe arrhythmia occurred in two of the patients with atrial fibrillation while they were exercising vigorously, but did not occur with normal activity. Therefore, patients with atrial fibrillation who are being treated with flecainide may be susceptible to ventricular tachycardia or fibrillation. Exercise testing in patients who are treated with flecainide is necessary, as is the close monitoring of patients at the beginning of treatment and at any point where there is an increase in dosage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ventricular tachycardia

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Risk of initiating antiarrhythmic drug therapy for atrial fibrillation in patients admitted to a university hospital

Article Abstract:

Patients treated with medications to correct an abnormal heart rhythm called atrial fibrillation appear to be at increased immediate risk for other heart complications. The incidence of heart complications was analyzed among 417 patients treated with either amiodarone, procainamide, sotalol, quinidine, propafenone, flecainide, or disopyramide. Serious heart complications occurred in 13.4% of these patients. Older patients and those who had experienced a previous heart attack were more likely to have serious complications. Most complications occurred during the first 24 to 48 hours of treatment.

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