Abstract
Flecainide is an IC antiarrhythmic drug (AAD) that received in 1984 Food and Drug Administration approval for the treatment of sustained ventricular tachycardia (VT) and subsequently for rhythm control of atrial fibrillation (AF). Currently, flecainide is mainly employed for sinus rhythm maintenance in AF and the treatment of idiopathic ventricular arrhythmias (IVA) in absence of ischaemic and structural heart disease on the basis of CAST data. Recent studies enrolling patients with different structural heart diseases demonstrated good effectiveness and safety profile of flecainide. The purpose of this review is to assess current evidence for appropriate and safe use of flecainide, 30 years after CAST data, in the light of new diagnostic and therapeutic tools in the field of ischaemic and non-ischaemic heart disease.
Highlights
Flecainide is a class IC antiarrhythmic drug (AAD) that was first synthesized in 1972
This review aims to do a critical appraisal of the use of flecainide in Ventricular Arrhythmia management in the light of the current evidence: is it still right to exclude flecainide from treatment for all patients with structural heart disease after 30 years?
Class IC alternative to beta blockers/verapamil Catheter Ablation after drug failure if >5 years Flecainide should be added to betablockers in case of recurrent syncope or bidirectional Ventricular Tachycardia (VT) Flecainide should be added to betablockers to reduce ICD appropriate shocks Sodium channel blockers as add-on to shorten QTc > 500 ms
Summary
Flecainide is a class IC antiarrhythmic drug (AAD) that was first synthesized in 1972 It was approved by Food and Drug Administration in 1984 for the treatment of symptomatic sustained Ventricular Tachycardia (VT), with a 90% efficacy and without significant adverse events [1,2]. The CAST study provided a major revision of the role of flecainide, which is recommended in selected patients with preserved systolic function and without ischaemic heart disease [6]. This review aims to do a critical appraisal of the use of flecainide in Ventricular Arrhythmia management in the light of the current evidence: is it still right to exclude flecainide from treatment for all patients with structural heart disease after 30 years?
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