Vol 20, No 2 (2013)
Case Reports
Published online: 2013-04-05

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Arrhythmogenic effect of flecainide toxicity

Pierre-Yves nd Courand, Franck Sibellas, Sylvain Ranc, Audrey Mullier, Gilbert Kirkorian, Eric Bonnefoy
DOI: 10.5603/CJ.2013.0035
Cardiol J 2013;20(2):203-205.

Abstract

Flecainide is a class 1C antiarrhythmic drug especially used for the management of
supraventricular arrhythmia. In overdose cases, flecainide can induce life treating ventricular
arrhythmias and cardiogenic shock. We report the case of a 72-year-old woman admitted to
our intensive care unit for a regular monomorphic wide complex tachycardia (QRS duration
240 ms, right bundle branch block and superior axis morphology) without apparent P waves.
Clinical examination showed slight left congestive heart failure signs without cardiogenic
shock. An intravenous bolus of 10 mg adenosine 5’-triphosphate (ATP) was ineffective to stop
the tachycardia. The diagnosis of ventricular tachycardia induced by flecainide overdose was
considered. 500 mL of intravenous 84‰ sodium bicarbonate was administrated. The patient’s
QRS narrowed immediately and 12-lead ECG showed sinus rhythm. Blood samples confirmed the
flecainide overdose and the clinical status progressively improved.