Falk R H
Boston City Hospital, Massachusetts.
Ann Intern Med. 1989 Jul 15;111(2):107-11. doi: 10.7326/0003-4819-111-2-107.
Flecainide acetate has a recognized proarrhythmic effect in patients treated for ventricular tachycardia. Three patients developed severe ventricular arrhythmias while taking flecainide for atrial fibrillation. Patient 1 had normal ventricular function and idiopathic atrial fibrillation. Treadmill exercise tests during digoxin therapy showed no ventricular arrhythmia; however, during flecainide therapy the patient developed ventricular flutter at his peak exercise level that required cardioversion. Patient 2 had normal ventricular function and a prosthetic mitral valve. During therapy with flecainide, 150 mg twice daily, he had an episode of sustained ventricular tachycardia, also at his peak exercise level. Patient 3 had paroxysmal atrial fibrillation and hypertrophic cardiomyopathy but no previous ventricular arrhythmia. She died suddenly within 10 days of starting flecainide therapy. Judged from previous findings none of these patients was considered at high risk for proarrhythmia. These cases suggest a possible relation between vigorous exercise, atrial fibrillation, and the proarrhythmic properties of flecainide and indicate the limitations of classifying patients as "high-risk" or "low-risk" for proarrhythmic complications of anti-arrhythmic therapy.
醋酸氟卡尼在治疗室性心动过速的患者中具有公认的促心律失常作用。三名患者在服用氟卡尼治疗心房颤动时出现了严重的室性心律失常。患者1心室功能正常，患有特发性心房颤动。地高辛治疗期间的跑步机运动试验未显示室性心律失常；然而，在氟卡尼治疗期间，患者在运动峰值水平时出现了心室扑动，需要进行心脏复律。患者2心室功能正常，有人工二尖瓣。在每日两次服用150 mg氟卡尼治疗期间，他在运动峰值水平时也出现了一次持续性室性心动过速。患者3患有阵发性心房颤动和肥厚型心肌病，但既往无室性心律失常。她在开始氟卡尼治疗后10天内突然死亡。根据既往研究结果，这些患者均未被认为有发生促心律失常的高风险。这些病例提示剧烈运动、心房颤动与氟卡尼的促心律失常特性之间可能存在关联，并表明将患者分类为抗心律失常治疗促心律失常并发症的“高风险”或“低风险”存在局限性。
