Flecainide: Current status and perspectives in arrhythmia management

Abstract

Flecainide acetate is a class IC antiarrhythmic agent and its clinical efficacy has been confirmed by the results of several clinical trials. Nowadays, flecainide is recommended as one of the first line therapies for pharmacological conversion as well as maintenance of sinus rhythm in patients with atrial fibrillation and/or supraventricular tachycardias. Based on the Cardiac Arrhythmia Suppression Trial study results, flecainide is not recommended in patients with structural heart disease due to high proarrhythmic risk. Recent data support the role of flecainide in preventing ventricular tachyarrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia associated both with ryanodine receptor and calsequestrin mutations. We herein review the current clinical data related to flecainide use in clinical practice and some concerns about its role in the management of patients with coronary artery disease.

Keywords: Atrial fibrillation; Class IC antiarrhythmic drugs; Flecainide; Proarrhythmia; Ventricular tachycardia.

Figures

Figure 1

Chemical structure of flecainide acetate.

Figure 2

Mechanism of flecainide action during atrial fibrillation by inhibition of Na+ channels which reduces intracellular Ca2+ accumulation and reduces oxidative stress and mitochondrial dysfunction. AF; Atrial fibrillation; INa: Fast inward Na+ current; ROS: Reactive oxygen species; NFκB: Nuclear factor kappa β; ATP: Adenosine triphosphate.