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Hemodynamic and ECG effects of intravenous flecainide were assessed in 10 patients with acute myocardial infarction and no symptoms or signs of heart failure. The dose was 2 mg/kg injected over a 15-minute period. R-R interval did not change, but PR interval and QRS increased significantly, 28% (p less than 0.0005) and 20% (p less than 0.05), respectively. Duration of P wave also increased significantly, 15% (p less than 0.02). Pulmonary wedge pressure increased 29% (p less than 0.005) and cardiac index and left ventricular stroke work index decreased 9% (p less than 0.05) and 20% (p less than 0.05), respectively. No significant change in mean aortic pressure and systemic vascular resistance occurred. Thus, intravenous flecainide has a mild and transient negative inotropic effect in patients with noncomplicated acute myocardial infarction. It did not induce ventricular failure in this group of patients but should be administered cautiously to patients with overt heart failure or severe conduction defects.

Sudden death is a frequent cause of mortality worldwide, affecting people with either known or unknown heart disease. Coronary artery disease is its most common etiology. 1 The causal mechanisms of sudden death have become better understood with the study of animal models 2 and patients resuscitated from cardiac arrest. 3,4 Patients in whom an electrocardiographic recording is available at the time of death offer valuable information, but are scarce. 5–18 We present data from 8 patients with coronary artery disease in whom out-of-hospital cardiac arrest was documented by ambulatory electrocardiographic recording.