Flecainide Toxicity in a Patient with a Functioning Pacemaker.

Sneha Chebrolu,Jonathan Mayl,Prashant Bhave

The Journal of innovations in cardiac rhythm management（2024）

Department of Internal Medicine | Department of Cardiology

Cited 0|Views2

Abstract

Flecainide is a class Ic anti-arrhythmic that demonstrates use dependence, meaning the medication has an increased effect on the myocardium at high heart rates. Flecainide toxicity can be identified by wide QRS complexes on an electrocardiogram (ECG). We discuss a case of a 75-year-old patient with a pacemaker who presented with concern for flecainide toxicity. The patient had several risk factors known to increase the likelihood for toxicity, including structural heart disease and acute kidney injury. The initial ECG showed tachycardia with wide QRS complexes. The patient had a pacemaker set in a tracking mode (DDD) that resulted in rapid ventricular pacing with failure to mode switch. However, with modification to the VVI mode, the patient experienced tachycardia resolution with an improvement in QRS complexes. This case emphasizes the use dependence of flecainide and illustrates the utility of pacing mode in the management of flecainide toxicity in patients with pacemakers.

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【要点】：本文报道了一例75岁带有起搏器的患者出现氟卡尼毒性的案例，并探讨了起搏器模式调整在管理此类毒性中的有效性。

【方法】：通过分析患者的病史、心电图变化以及起搏器模式的调整，研究了氟卡尼在心脏中的使用依赖性及其毒性反应。

【实验】：病例研究，患者初始起搏器设置为DDD模式，后调整为VVI模式，观察QRS复合波的改善及心动过速的解决情况；未提及具体数据集名称。