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 BRAND NAMES
- Almarytm (Italy)
- Apocard (Belgium, Luxembourg, Spain)
- Flecaine (Tunisia, France)
- Tambocor (International)
 MECHANISM OF ACTION
Flecainide is the prototype drug of class Ic antiarrhythmics.
Flecainide produces a dose related decrease in intracardiac conduction (by slowing the influx of sodium) in all parts of the heart with the greatest effect on the His-Purkinje system (H-V conduction). The electrophysiological effect of propafenone manifests itself in a reduction of phase 0 depolarization (decreasing Vmax)
Flecainide affects the electrocardiograph (ECG) by widening the PR interval and by prolonging the duration of the QRS complex. The widened QRS complex (ventricular depolarisation) results in a longer QT interval but there is little specific effect on the JT interval (ventricular repolarisation).
Sinus node function may also be affected particularly in patients with intrinsic sinus node disease
Flecainide has a negative inotropic effect and can aggravate congestive heart failure
Flecainide is indicated for the prevention of
- paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia and other supraventricular tachycardias of unspecified mechanism associated with disabling symptoms
- paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms
- documented ventricular arrhythmias, such as sustained ventricular tachycardia (sustained VT), that in the judgment of the physician are life-threatening.
Use of Flecainide for the treatment of sustained VT, like other antiarrhythmics, should be initiated in the hospital. The use of Flecainide is not recommended in patients with less severe ventricular arrhythmias even if the patients are symptomatic.
Because of the proarrhythmic effects of Flecainide, its use should be reserved for patients in whom, in the opinion of the physician, the benefits of treatment outweigh the risks.
Flecainide should not be used in patients with recent myocardial infarction.
Use of Flecainide in chronic atrial fibrillation has not been adequately studied and is not recommended.
As is the case for other antiarrhythmic agents, there is no evidence from controlled trials that the use of Flecainide favorably affects survival or the incidence of sudden death.
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