Anastasiou-Nana M I, Anderson J L, Stewart J R, Crevey B J, Yanowitz F G, Lutz J R, Johnson T A
Am Heart J. 1987 May;113(5):1071-7. doi: 10.1016/0002-8703(87)90914-8.
Flecainide acetate, a new antiarrhythmic agent, possesses favorable pharmacokinetic and hemodynamic properties and demonstrates highly favorable antiarrhythmic activity in patients with ventricular arrhythmias. However, the proarrhythmic potential of flecainide deserves further evaluation. In 7 (13%) of 55 consecutive patients treated with oral flecainide, 200 to 600 mg/day, for complex ventricular arrhythmias (including sustained ventricular tachycardia in 14), we observed the appearance of new or more sustained exercise-induced (five patients) or spontaneous (two patients) wide complex tachycardia. The mechanism of wide complex tachycardia appeared to be ventricular tachycardia in all seven. In our series, episodes were self-remitting or successfully treated. In four patients, wide complex tachycardia did not recur during exercise testing during alternative antiarrhythmic therapy (three patients) or no antiarrhythmic therapy (one patient). These observations raise the possibility of flecainide-related proarrhythmia, manifested as an increased propensity to exercise (activity)-induced wide complex tachycardia, which was not reliably predicted by results of Holter recordings or programmed electrical stimulation. Patients with complex ventricular arrhythmias beginning long-term treatment with oral flecainide should be considered for treadmill exercise testing together with ambulatory monitoring as part of the initial assessment of drug efficacy.
醋酸氟卡尼是一种新型抗心律失常药物，具有良好的药代动力学和血流动力学特性，在室性心律失常患者中显示出高度良好的抗心律失常活性。然而，氟卡尼的促心律失常潜力值得进一步评估。在连续55例接受口服氟卡尼治疗的患者中，200至600毫克/天，用于治疗复杂性室性心律失常（包括14例持续性室性心动过速），我们观察到7例（13%）出现了新的或更持续的运动诱发（5例患者）或自发（2例患者）的宽QRS波心动过速。所有7例患者宽QRS波心动过速的机制似乎都是室性心动过速。在我们的系列研究中，发作均自行缓解或成功治疗。在4例患者中，在替代抗心律失常治疗（3例患者）或无抗心律失常治疗（1例患者）期间进行运动试验时，宽QRS波心动过速未复发。这些观察结果增加了氟卡尼相关促心律失常的可能性，表现为运动（活动）诱发宽QRS波心动过速的倾向增加，这无法通过动态心电图记录或程控电刺激结果可靠预测。对于开始长期口服氟卡尼治疗复杂性室性心律失常的患者，应考虑进行平板运动试验和动态监测，作为药物疗效初始评估的一部分。
