Flecainide toxicity in a neonate with supraventricular tachycardia

Article Abstract:

Antiarrhythmic drugs are used to treat patients with abnormal heart beat. Flecainide and encainide (class IC antiarrhythmic drugs) are very potent and are used to treat patients with tachyarrhythmia (abnormally fast heart rate). Like many other drugs used to treat arrhythmias, these drugs can have serious adverse effects and may cause the same heart abnormality that they are used to treat. While flecainide and encainide can successfully treat tachyarrhythmia, they may also make the tachyarrhythmia become worse and can cause death. Therefore, the use of these agents in treating adults and children with tachyarrhythmia has been questioned. This article describes the case report of a two and a half week old infant who had a toxic reaction to treatment with flecainide for tachyarrhythmia. The abnormal heart rhythm was first detected in utero at weeks 25 of gestation. The baby was delivered at week 38 of gestation and was admitted to the neonatal intensive care unit for heart rate monitoring. The baby experienced several episodes of tachycardia that resolved spontaneously. The infant was treated with digitalis and remained stable until the fifth day of life when the tachyarrhythmia became worse. Treatment with digoxin and propranolol was commenced, but did not improve the baby's condition. On day 11, treatment with flecainide was initiated. On day 18 the baby had a toxic reaction to the flecainide and was near cardiogenic shock. Intravenous sodium bicarbonate was administered to counteract the flecainide and within 48 hours the baby recovered. Medical intervention was then abandoned and surgery proved to be successful. This case illustrates that treatment of tachyarrhythmias in children, especially neonates, can be very difficult. When class IC agents such as flecainide are used, the patient must be monitored carefully for any signs of a toxic reaction. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Complications and side effects, Tachycardia, Ventricular tachycardia

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Treatment of fetal supraventricular tachycardia with flecainide acetate after digoxin failure

Article Abstract:

Tachycardia (rapid heart rate) is a common problem, and can be classed according to whether changes in the heart rate are caused by problems in the ventricle (lower heart chamber) or in the atrium (upper heart chamber). The latter disorder is also called supraventricular tachycardia. Although many drugs are available to treat heart arrhythmias, treatment of fetal supraventricular tachycardia can be difficult. Digoxin is most commonly used, alone or with other drugs. A case is described in which digoxin was ineffective in treating fetal supraventricular tachycardia, but the condition was successfully treated with flecainide. The 22-year-old mother was evaluated at 31 weeks of gestation for fetal arrhythmia. Fetal ascites (fluid accumulation, related to ineffective movement of blood through the body) was present. Echocardiography showed that the fetal heart was structurally normal but moderately enlarged. After non-responsiveness to digoxin, flecainide was started, and the heart rate normalized over 96 hours. No maternal side effects occurred. The two drugs were discontinued after 56 hours due to changes in fetal behavior, but the abnormal heart rate returned. Flecainide therapy was then resumed, and after stabilization of heart rate, the dose was slowly decreased. Blood flow through the heart and heart size normalized within 20 days, and ascites resolved within 10 days. The fetus was delivered at 41 weeks of gestation in good condition and at normal birth weight. Digoxin was started as a preventive measure on the second day. The study suggests that flecainide may be safe and effective in treatment of fetal tachycardia that is unresponsive to digoxin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Congenital heart disease, Congenital heart defects, Fetal heart, Supraventricular tachycardia

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Functional asymmetry of the human myometrium documented by color and pulsed-wave Doppler ultrasonographic evaluation of uterine arcuate arteries during Braxton Hicks contractions

Article Abstract:

Blood flow velocity to the myometrium during Braxton Hicks contractions appears to depend on whether the artery is supplying placental or non-placental myometrium. Myometrium (uterine muscle) located near the placenta contracts less than myometrium located further away. Braxton Hicks contractions are generally painless, irregular uterine contractions that occur during pregnancy. Using Doppler ultrasound imaging, 20 healthy pregnant women were monitored during Braxton Hicks contractions. In patients who had contractions arising from placental myometrium, arterial resistance, which is a measure of blood flow velocity, was normal during and after the contraction. In patients in whom the contractions developed in the non-placental myometrium, artery resistance rose significantly during contractions. Increasing resistance slows the blood flow and most likely reduces the blood supply to the myometrium.

Physiological aspects, Uterus, Myometrium, Uterine circulation

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