title: Impact of serum flecainide level on control of atrial fibrillation in a case treated with cardiac resynchronization therapy.
abstract: A 72-year-old male patient with dilated cardiomyopathy was treated with oral flecainide (100 mg/day) for persistent atrial fibrillation (AF) that could not be converted to sinus rhythm by electrical cardioversion. Initiation of flecainide treatment provided sinus rhythm without prolongation of QRS and QTc, bradycardia and first-degree atrioventricular block at a serum flecainide level of 438 ng/mL. Then, he received cardiac resynchronization therapy (CRT). Dose reduction to 50 mg/day because of stabilization of heart rate after CRT produced AF at a serum flecainide level of 270 ng/mL. Electrical cardioversion did not restore the AF to a sinus or pacing rhythm. Dose escalation of flecainide (to 100 mg/day) restored the pacing rhythm at a serum flecainide level of 401 ng/mL. This case suggests that in the Japanese population, serum flecainide level should be maintained at >300 ng/mL to control AF even after effective CRT.
authors.affiliation: Department of Pharmaceutical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Doki
authors.forename: M
authors.initials: M
authors.lastname: Homma
authors.forename: K
authors.initials: K
authors.lastname: Kuga
authors.forename: S
authors.initials: S
authors.lastname: Kawano
authors.forename: K
authors.initials: K
authors.lastname: Aonuma
authors.forename: I
authors.initials: I
authors.lastname: Yamaguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Kohda
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002304:Cardiac Pacing, Artificial; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy*; D003577:Cytochrome P-450 Enzyme System; D004305:Dose-Response Relationship, Drug; D004554:Electric Countershock; D004562:Electrocardiography; D005424:Flecainide / Q000008:administration & dosage / Q000493:pharmacokinetics*; D005838:Genotype; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007564:Japan; D008297:Male; D011110:Polymorphism, Genetic
chemical_list: D000889:Anti-Arrhythmia Agents; D003577:Cytochrome P-450 Enzyme System; D005424:Flecainide