ABSTRACT
Flecainide is an antiarrhythmic drug that blocks sodium channels during phase 0 of cardiac action potential, delaying conduction and reducing contractility. Intoxication by this drug is rare. Onset of effect, which is rapid, takes the form of hypotension and cardiac arrhythmias; mortality is high. No antidote is available and management is based on the few cases that have been reported. The metabolism of flecainide is affected by both kidney and liver failure, which lead to accumulation of the drug. Flecainide should not be used in patients with such failure unless the potential benefits clearly outweigh the risks. If flecainide is prescribed, diligent clinical, electrocardiographic, and hemodynamic vigilance is imperative and plasma levels of the drug should be monitored. We report a case of flecainide poisoning in which the drug was prescribed to treat atrial fibrillation in a woman with resolving sepsis with renal and hepatic complications.
Subject(s)
Atrial Fibrillation/drug therapy , Flecainide/poisoning , Intraoperative Complications/drug therapy , Sodium Channel Blockers/poisoning , Aged , Amiodarone/therapeutic use , Cholecystectomy , Cholecystitis/complications , Cholecystitis/surgery , Electrocardiography , Emergencies , Female , Flecainide/blood , Flecainide/pharmacokinetics , Flecainide/therapeutic use , Humans , Kidney/metabolism , Kidney/physiopathology , Liver/metabolism , Liver/physiopathology , Long QT Syndrome/chemically induced , Postoperative Complications/drug therapy , Postoperative Complications/metabolism , Postoperative Complications/physiopathology , Pulmonary Edema/etiology , Sepsis/complications , Sepsis/metabolism , Sepsis/physiopathology , Sodium Channel Blockers/blood , Sodium Channel Blockers/pharmacokinetics , Sodium Channel Blockers/therapeutic useABSTRACT
La flecainida es un antiarrítmico que actúa bloqueando los canales de sodio durante la fase 0 del potencial de acción, retardando la conducción cardiaca y disminuyendo la contractilidad. La intoxicación por este fármaco es muy infrecuente, con un inicio de acción rápido en forma de hipotensión y arritmias cardiacas y una alta mortalidad. No existe antídoto y su tratamiento está basado en la experiencia de los escasos casos descritos. Tanto la insuficiencia renal como hepática pueden alterar el metabolismo de la flecainida, lo que ocasiona acúmulo de la misma. Es recomendable no utilizar flecainida en este tipo de casos a menos que los beneficios claramente superen los riesgos de su utilización. En tales casos es indispensable la vigilancia clínica, electrocardiográfica y hemodinámica, así como la monitorización de niveles plasmáticos. Presentamos un caso de intoxicación por flecainida para tratamiento de fibrilación auricular en un paciente con un cuadro séptico en resolución, que sufría afectación hepática y renal(AU)
Flecainide is an antiarrhythmic drug that blocks sodium channels during phase 0 of cardiac action potential, delaying conduction and reducing contractility. Intoxication by this drug is rare. Onset of effect, which is rapid, takes the form of hypotension and cardiac arrhythmias; mortality is high. No antidote is available and management is based on the few cases that have been reported. The metabolism of flecainide is affected by both kidney and liver failure, which lead to accumulation of the drug. Flecainide should not be used in patients with such failure unless the potential benefits clearly outweigh the risks. If flecainide is prescribed, diligent clinical, electrocardiographic, and hemodynamic vigilance is imperative and plasma levels of the drug should be monitored. We report a case of flecainide poisoning in which the drug was prescribed to treat atrial fibrillation in a man with resolving sepsis with renal and hepatic complications(AU)
