Evaluation of flecainide acetate in rapid atrial fibrillation complicating wolff‐parkinson‐white syndrome

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 8; no. 6; pp. 321 - 326
• Main Authors: Kappenberger, L. J., Fromer, M. A., Shenasa, M., Gloor, H. O.
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01.06.1985; Wiley
• Subjects: accessory AV pathway; Adolescent; Adult; Anti-Arrhythmia Agents - therapeutic use; Antiarythmic agents; Atrial Fibrillation - drug therapy; Biological and medical sciences; Cardiac Pacing, Artificial; Cardiovascular system; Electrocardiography; electrophysiologic study; Female; Flecainide; flecainide acetate; Heart Rate - drug effects; Humans; Infusions, Parenteral; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Piperidines - therapeutic use; Wolff-Parkinson-White Syndrome - drug therapy; Human; Chemotherapy; Arrhythmia; Respiratory disease; Atrial fibrillation; Electrophysiology; Complication; Wolff Parkinson White syndrome
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.4960080603

Flecainide is reported to be effective in patients with paroxysmal tachycardias, but its effect on rapid ventricular response over accessory atrioventricular pathway during atrial fibrillation is not known. The influence of flecainide on various electrophysiological properties of the accessory pathway with special emphasis on ventricular rate during atrial fibrillation was investigated in 9 patients with severe symptomatic Wolff‐Parkinson‐White syndrome. The shortest ventricular response during atrial fibrillation increased from 218 (190‐270) to 320 (240‐block) ms. In 4 patients sustained rapid atrial fibrillation converted to sinus rhythm. The rate of circus movement tachycardia decreased from 166/min to 130/min after flecainide, due to a lengthening of retrograde ventriculoatrial conduction time over the accessory pathway. Flecainide caused a significant prolongation of the effective refractory period of the accessory pathway in our subgroup with extremely fast AV conduction during atrial fibrillation and induced a depressant effect on retrograde accessory pathway conduction. This makes the drug very promising for the emergency treatment of dangerous rapid tachyarrhythias complicating this syndrome.