Flecainide
Flecainide
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Flecainide

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Flecainide

Flecainide is a medication used to prevent and treat abnormally fast heart rates. This includes ventricular and supraventricular tachycardias. Its use is only recommended in those with dangerous arrhythmias or when significant symptoms cannot be managed with other treatments. Its use does not decrease a person's risk of death. It is taken by mouth or injection into a vein.

Common side effects include dizziness, problems seeing, shortness of breath, chest pain, and tiredness. Serious side effects may include cardiac arrest, arrhythmias, and heart failure. It may be used in pregnancy, but has not been well studied in this population. Use is not recommended in those with structural heart disease or ischemic heart disease. Flecainide is a class Ic antiarrhythmic agent. It works by decreasing the entry of sodium in heart cells, causing prolongation of the cardiac action potential.

Flecainide was approved for medical use in the United States in 1985. It is available as a generic medication. In 2023, it was the 223rd most commonly prescribed medication in the United States, with more than 1 million prescriptions.

Flecainide is used in the treatment of many types of supraventricular tachycardias, including AV nodal reentrant tachycardia (AVNRT) and Wolff-Parkinson-White syndrome (WPW).

It also has limited use in the treatment of certain forms of ventricular tachycardia (VT). In particular, flecainide has been useful in the treatment of ventricular tachycardias that are not in the setting of an acute ischemic event. It has use in the treatment of right ventricular outflow tract (RVOT) tachycardia and in the suppression of arrhythmias in arrhythmogenic right ventricular dysplasia (ARVD). Studies (notably the Cardiac Arrhythmia Suppression Trial) have shown an increased mortality when flecainide is used to suppress ventricular extrasystoles in the setting of acute myocardial infarction.

Flecainide can be used for the management of atrial fibrillation.

In individuals suspected of having the Brugada syndrome, the administration of flecainide may help reveal the electrocardiography (ECG) findings that are characteristic of the disease process. This may help make the diagnosis of the disease in equivocal cases.

In the long-term, flecainide seems to be safe in people with a healthy heart with no signs of left ventricular hypertrophy, ischemic heart disease, or heart failure.

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