Efficacy of flecainide in patients with supraventricular arrhythmias and respiratory insufficiency.

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 exacerbation 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.