Older female relatives of Covid-19 patients have an unsatisfactory perception of emergency room performance by clinical staf

Flecainide is a class I antiarrhythmic used for supraventricular tachyarrhythmias with mild adverse reactions. We present a case report in a 78-year-old male that came to the emergency department with atrial fibrillation and was subsequently treated with flecainide. During the infusion, the patient went into cardiac arrest. Cardiopulmonary resuscitation was performed until the return of spontaneous circulation was achieved after 1min and 40 seconds. Conclusion. Some trials, like The Cardiac Arrhythmia Suppression Trial (CAST), consider flecainide to be safe, but our case report, together with several other published reports brings attention to the use of flecainide in pharmacologic cardioversion of atrial fibrillation as a cause of cardiac arrest. Keywords: Older man, atrial fibrillation, emergency department, cardiac arrest, flecainide

Cardiac arrest in an older male patient treated with flecainide for atrial fibrillation

Flecainide is a class I antiarrhythmic used for supraventricular tachyarrhythmias with mild adverse reactions.We present a case report in a 78-year-old male that came to the emergency department with atrial fibrillation and was subsequently treated with flecainide. During the infusion, the patient went into cardiac arrest. Cardiopulmonary resuscitation was performed until the return of spontaneous circulation was achieved after 1 min and 40 seconds. Conclusion. Some trials, like The Cardiac Arrhythmia Suppression Trial (CAST), consider flecainide to be safe, but our case report, together with several other published reports brings attention to the use of flecainide in pharmacologic cardioversion of atrial fibrillation as a cause of cardiac arrest. Keywords: Older man, atrial fibrillation, emergency department, cardiac arrest, flecainide

Abstract 14840: Ability of Coronary Calcium Absence to Predict Negative Stress Test Results in Patients Considered for Flecainide Therapy

Background: Flecainide is a useful antiarrhythmic for atrial fibrillation (AF). However, the Cardiac Arrhythmia Suppression Trial (CAST) showed an increased risk of fatal ventricular arrhythmia with flecainide use after myocardial infarction (MI). Thus, a history of MI or coronary artery disease (CAD) is a flecainide exclusion, and stress testing is used to exclude ischemia. We assessed whether absence of coronary artery calcium (CAC) can obviate the need for stress testing. Methods: We assessed ischemic burden using regadenoson Rb-82 PET/CT in 1375 AF patients (pts) ≥50 y old without clinical CAD. CAC was determined qualitatively in these pts by low dose attenuation CT (n=816) or by quantitative CT (n=559). The primary comparison was percentage of pts with ischemic burden ≥5% by CAC presence or absence. Results: Pts with CAC absent (n=433, 31.5%) were younger, heavier, with lower rates of diabetes, hypertension, and dyslipidemia. Average ischemic burden was lower in CAC-absent pts (0.8 ± 3.1 v 1.3 ± 3.7, p=0.04), and a favorable difference trend in ischemic burden ≥5% was noted that did not reach significance (7.2% v 9.7% p=0.15). CAC-absent pts showed greater coronary flow reserve (2.4 v 2.3, p=0.002) and trended to have fewer referrals for coronary angiography (1.6% v 4.0% adjusted[adj]*-p=0.10), fewer findings of obstructive CAD (1.4% v 3.5% adj-p=0.12), and lower rates of 90-day MACE (1.6% v 3.5%, adj-p=0.12); long-term MACE were fewer (5.3% v 7.0% adj-p=0.04). Conclusions: Our results support the hypothesis that an easily administered, inexpensive, low radiation CAC scan may identify a subset of flecainide candidates with a low ischemic burden on PET stress testing and that rarely need coronary angiography/intervention. CAC-absence combined with other clinical information may obviate the need for routine stress testing in selected flecainide candidates. Larger and randomized trials are indicated to confirm these findings and apply CAC use in clinical practice.

Atrial Fibrillation and Flecainide – Safety, Effectiveness and Quality of Life Outcomes

Flecainide is a class IC antiarrhythmic agent indicated for patients with atrial fibrillation without any evidence of structural heart disease. This brief review of four recent studies on flecainide focuses on safety aspects, efficacy and the debate on impact on quality of life in this patient population. This article also briefly summarises data from the Cardiac Arrhythmia Suppression Trial (CAST) and the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study, which investigated the effect of antiarrhythmics such as flecainide on morbidity and mortality. When administered according to recommended guidelines, flecainide is safe and is not associated with increased mortality. It is effective for the treatment of atrial fibrillation, improving quality of life in these patients.