[Life-threatening ventricular tachycardia during flecainide treatment for symptomatic atrial fibrillation in a patient with a structural cardiac disorder].
A 37-year-old man with symptomatic acute atrial fibrillation and a low-voltage electrocardiogram was treated with flecainide intravenously. Instead of conversion to sinus rhythm, he developed a wide-complex tachycardia suggestive of ventricular tachycardia. The patient recovered following electric cardioversion. First-choice therapy for symptomatic atrial fibrillation of recent onset (duration < 48 hours) is chemical conversion with a class IC antiarrhythmic drug (e.g. flecainide, propafenone). However, in patients with structural heart disorders, these drugs may induce ventricular tachycardia. A low-voltage electrocardiogram is suggestive of left ventricular damage. For these patients, electric cardioversion is a better alternative.
Rienstra
M
M
Universitair Medisch Centrum Groningen, Thoraxcentrum, afd. Cardiologie, RB Groningen.
Wiesfeld
A C P
AC
van Veldhuisen
D J
DJ
van Gelder
I C
IC
D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D004562:Electrocardiography; D005424:Flecainide / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D017180:Tachycardia, Ventricular / Q000139:chemically induced*; D016896:Treatment Outcome; D016276:Ventricular Function / Q000187:drug effects / Q000502:physiology
D000889:Anti-Arrhythmia Agents; D005424:Flecainide