Flecainide overdose – support using an intra-aortic balloon pumpReport as inadecuate

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BMC Emergency Medicine

, 5:10

First Online: 12 December 2005Received: 15 July 2005Accepted: 12 December 2005DOI: 10.1186-1471-227X-5-10

Cite this article as: Timperley, J., Mitchell, A.R., Brown, P.D. et al. BMC Emerg Med 2005 5: 10. doi:10.1186-1471-227X-5-10


BackgroundFlecainide is an antiarrhythmic agent which is being used increasingly for the management of super-ventricular arrhythmias. Overdose with flecainide is frequently fatal with mortality reported as high as 22% due to arrhythmias, myocardial depression and conduction defects leading to electro-mechanical dissociation and asytole. Supportive measures are often required during the case and previously have included inotropes, extracorporeal membrane oxygenation and cardiopulmonary bypass.

Case presentationA 47 year old lady presented to the emergency department with a four hour history of severe central chest pain. Her ECG showed atrial fibrillation and broad QRS complexes with a sine wave appearance. She had a past history of paroxysmal atrial fibrillation and significant psychiatric history. Following thrombolysis for a presumed myocardial infarction she developed cardiogenic shock with severely impaired left ventricular function. An intra-aortic balloon pump was inserted and coronary angiography demonstrated normal coronary arteries. With inotropic support she improved over 48 hours, with both her QRS duration and left ventricular function returning to normal. Biochemical testing following her discharge demonstrated significantly elevated levels of flecainide.

ConclusionThe use of an intra-aortic balloon pump is a useful supportive measure during the acute phase of flecainide overdose associated with severe myocardial depression.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-227X-5-10 contains supplementary material, which is available to authorized users.

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Author: Jonathan Timperley - Andrew RJ Mitchell - Peter D Brown - Nicholas EJ West

Source: https://link.springer.com/

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