Abstract
Objective
Evaluation of efficacy of intravenous flecainide to revert supraventricular arrhythmias to sinus rhythm in patients with respiratory insufficiency.
Design
Comparative randomized prospective trial.
Setting
ICU in a University Hospital
Patients
30 patients with acute respiratory insufficiency or acute exscerbation of chronic respiratory insufficiency and supraventricular arrhythmias. Intravenous flecainide was administered to 15 patients (Group A) (2 mg/kg for 10 min and continuous perfusion of 1.5 mg/kg for 1 h). Intravenous verapamil was administered to 15 patients (Group B) (0.15 mg/kg for 5 min and continuous perfusion of 0.005 mg/kg/min for 1 h).
Measurements and results
The categories of patients' arrhythmias were: Group A — atrial fibrillation (AF) in 5 cases, atrial flutter (AFl) in 2, multifocal atrial tachycardia (MAT) in 4 and other supraventricular tachycardia (SVT) in 4. Group B — AF in 6 cases, AFL in 2, MAT in 2 and SVT in 5 cases. Flecainide reverted arrhythmias to sinus rhythm in 12 out of 15 cases (80%); of these 12, 11 reverted with the initial bolus. Verapamil reverted 5 out of 12 cases (33.3%,p<0.01). No significant secondary adverse effects were detected.
Conclusion
Intravenous flecainide is an effective antiarrhythmic drug to treat acute supraventricular arrhythmias in patients with respiratory insufficiency.
References
Hudson L, Kurt T, Petty T, Genton E (1973) Arrhythmias associated with acute respiratory failure in patients with chronic airway obstruction. Chest 63:661–665
Holford F, Mithoefer J (1973) Cardiac arrhythmias in hospitalized patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 108:879–885
Johanson W, Peters J (1988) Complications and philosophy. In: Murray J, Nadel J (eds) Textbook of respiratory medicine. Saunders, Philadelphia, pp 2035–2054
Smith W, Gallagher J (1986) Mechanisms of arrhythmias and conduction abnormalities. In: Hurst J (ed) The heart. McGraw-Hill, Baskerville, pp 406–432
Edwards JD (1986) Management of intractable supraventricular arrhythmias in the ICU. In: Vincent JL (ed) Update in intensive care and emergency medicine. Springer, Berlin Heidelberg New York Tokyo, pp 169–171
Berns E, Rinkenberger R, Jeang M, Dougherty A, Jenkins M, Naccarelli G (1987) Efficacy and safety of flecainide acetate for atrial tachycardia or fibrillation. Am J Cardiol 59:1337–1341
Hellestrand K (1988) Intravenous flecainide acetate for supraventricular tachycardias. Am J Cardiol 62:16D-22D
Barranco F, Blasco J, Lesmes A (1990) Eficacia de la Flecainida en las arritmias supraventriculares en el curso de la insuficiencia respiratoria aguda. Med Intens 24:363–366
Ferrando C, Cabades A, Castro J, Rucabado L, Quintana O, Ruano M (1980) Amiodarona endovenosa en el tratamiento de arritmias supraventriculares. Med Intens 4:116–119
Arsura E, Lefkin A, Scher D, Solar M (1988) A randomized, double-blind, placebo-controlled study of verapamil and metoprolol in treatment of multifocal atrial tachycardia. Am J Cardiol 85:519–524
Roden D, Woosley R (1986) Drug therapy. Flecainide. N Engl J Med 315:36–41
The Cardiac Arrhythmia Suppression Trial (CAST) investigators (1989) Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 321:406–412
Flecainide and CAST (Editorial) (1989) Lancet II:481–482
Pritchett E, Wilkinson W (1991) Mortality in patients treated with flecainide and encainide for supraventricular arrhythmias. Am J Cardiol 67:976–980
Scher D, Arsura E (1989) Multifocal atrial tachycardia: Mechanisms, clinical correlates, and treatment. Am Heart J 118:574–580
Roden D (1988) Role of the electrocardiogram in determining electrophysiologic end points of drug therapy. Am J Cardiol 62:34H-38H
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Barranco, F., Sanchez, M., Rodriguez, J. et al. Efficacy of flecainide in patients with supraventricular arrhythmias and respiratory insufficiency. Intensive Care Med 20, 42–44 (1994). https://doi.org/10.1007/BF02425054
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DOI: https://doi.org/10.1007/BF02425054