5,503 results on '"Flecainide"'
Search Results
2. INhalation of Flecainide to Convert Recent Onset SympTomatic Atrial Fibrillation to siNus rhyThm (INSTANT) (INSTANT)
- Published
- 2024
3. Single Dose Flecainide for Early Sinus Rhythm Conversion of Perioperative Atrial Fibrillation After Noncardiac Surgery (FLIP-AF)
- Published
- 2024
4. Prospective Multicenter Randomized and Controlled Study Evaluating the Benefit of Early Pulmonary Vein Isolation Compared to Usual Treatment in Patients Aged Over 75 Years and Presenting With Atrial Fibrillation (EDearly AF)
- Published
- 2024
5. Pulsed Field Ablation (PFA) Versus Anti-Arrhythmic Drug (AAD) Therapy as a First Line Treatment for Persistent Atrial Fibrillation (AVANT GUARD)
- Published
- 2024
6. Effect and Safety of Flecainide and Metoprolol Versus Metoprolol Alone to Suppress Ventricular Arrhythmias in Arrhythmic Mitral Valve Prolapse (FLECAPRO)
- Author
-
The Research Council of Norway, University of Oslo, and Kristina Hermann Haugaa, Professor
- Published
- 2024
7. Assessment of Flecainide to Lower the Patent Foramen Ovale Closure Risk of Atrial Arrhythmia or Tachycardia (AFLOAT)
- Author
-
Fonds de Dotation ACTION
- Published
- 2024
8. N-of-1 in ATS and MEPPC
- Author
-
Christian van der Werf, MD, PhD
- Published
- 2024
9. Case Files from the University of California San Diego Medical Toxicology Fellowship: Neonatal Flecainide Toxicity from an Accidental Dosing Error.
- Author
-
Seltzer, Justin and Schneir, Aaron
- Subjects
- *
ARRHYTHMIA , *FLECAINIDE , *MEDICAL fellowships , *HEART assist devices - Abstract
This article discusses a case of neonatal flecainide toxicity resulting from a dosing error. It explores the narrow therapeutic index of flecainide and the potential for toxicity in pediatric patients. The article highlights previous cases of dosing errors and their adverse effects. It also discusses the use of activated charcoal and sodium bicarbonate as treatments for flecainide toxicity, as well as other interventions that have shown promise. The document concludes by suggesting measures to prevent dosing errors in the pediatric population. [Extracted from the article]
- Published
- 2024
- Full Text
- View/download PDF
10. Diagnosis of Brugada Syndrome With a Sodium- Channel-Blocker Test: Who Should Be Tested? Who Should Not?
- Author
-
Viskin, Sami, Chorin, Ehud, Rosso, Raphael, Amin, Ahmad S., and Wilde, Arthur A.
- Subjects
- *
SODIUM channel blockers , *VENTRICULAR fibrillation , *ASYMPTOMATIC patients , *INTRAVENOUS therapy , *CARDIAC arrest - Abstract
Intravenous infusion of sodium-channel blockers (SCB) with either ajmaline, flecainide, procainamide, or pilsicainide to unmask the ECG of Brugada syndrome is the drug challenge most commonly used for diagnostic purposes when investigating cases possibly related to inherited arrhythmia syndromes. For a patient undergoing an SCB challenge, the impact of a positive result goes well beyond its diagnostic implications. It is, therefore, appropriate to question who should undergo a SCB test to diagnose or exclude Brugada syndrome and, perhaps more importantly, who should not. We present a critical review of the benefits and drawbacks of the SCB challenge when performed in cardiac arrest survivors, patients presenting with syncope, family members of probands with confirmed Brugada syndrome, and asymptomatic patients with suspicious ECG. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
11. Antiarrhythmic preferences and outcomes post DC cardioversion for atrial fibrillation, an Australian rural perspective.
- Author
-
Thomas, Martin, Elhindi, James, Kamaladasa, Kanishka, and Sirisena, Tilak
- Subjects
- *
ELECTRIC countershock , *RESEARCH funding , *SMOKING , *SCIENTIFIC observation , *KRUSKAL-Wallis Test , *MULTIPLE regression analysis , *AMIODARONE , *DESCRIPTIVE statistics , *RETROSPECTIVE studies , *CHI-squared test , *KAPLAN-Meier estimator , *ATRIAL fibrillation , *RURAL conditions , *PHYSICIAN practice patterns , *DRUG efficacy , *ADRENERGIC beta blockers , *FLECAINIDE , *LUNG diseases , *ONE-way analysis of variance , *POSTOPERATIVE period , *DRUG prescribing , *CEREBROVASCULAR disease , *DATA analysis software , *CONFIDENCE intervals , *MYOCARDIAL depressants , *LEFT ventricular dysfunction - Abstract
Introduction: Direct current cardioversion (DCCV) remains one of the recommended management strategies for symptomatic atrial fibrillation (AF). Antiarrhythmic drugs (AAD) are prescribed post procedure to maintain sinus rhythm (SR). Limited literature exists on the AAD prescribing practices and their efficacy, post‐DCCV in rural Australia. Objective: The primary aim was to determine the preferred AAD post‐DCCV and the factors affecting AAD prescribing practices. The secondary aim was to assess the efficacy of the AAD in maintaining SR. Design: A retrospective observational audit of patients with non‐valvular AF who underwent successful elective DCCV for symptomatic AF, during 2015–2020 at a regional hospital in New South Wales (NSW) (Dubbo Base Hospital). Patients were followed up for a duration of 12 months post‐DCCV. Results: 233 patients underwent successful DCCV during the study duration. Amiodarone was the preferred AAD of choice post‐DCCV followed by sotalol and flecainide, respectively (36.5% vs. 27.8% vs. 1.3%). 35.2% patients were not prescribed AAD. Amiodarone and sotalol had similar but modest efficacies and neither were superior to no AAD, in maintaining SR 12 months post‐DCCV (AF recurrence rate 61.5% vs. 68.2% vs. 71.6% respectively, p = 0.37). Antecedent cerebrovascular accident (CVA), pulmonary disease, smoking, prior treatment with digoxin, diuretics and left ventricular (LV) dysfunction were factors that influenced AAD prescribing practices. Conclusion: The study demonstrates equal efficacies of amiodarone, sotalol and no AAD in maintaining SR 12 months post‐DCCV. Prescribing practices post‐DCCV at Dubbo Base Hospital differ from observed national trends and guidelines. AAD prescription requires a multifaceted approach with a key consideration to prioritise safety over efficacy, being mindful of challenges in delivering optimal healthcare in a rural setting. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
12. Temperature and ST‐segment morphology remote monitoring: new perspectives for implantable cardiac monitors in Brugada syndrome.
- Author
-
Iacopino, Saverio, Sorrenti, Paolo, Fabiano, Emmanuel, Colella, Jacopo, Vilio, Alessandro Di, Statuto, Giovanni, Filannino, Pasquale, Artale, Paolo, Giacopelli, Daniele, Peluso, Gianluca, Fabiano, Gennaro, Campagna, Giuseppe, Cecchini, Edoardo, and Petretta, Andrea
- Subjects
- *
VITAL signs , *BRUGADA syndrome , *WEARABLE technology , *INFLUENZA , *TREATMENT effectiveness , *ELECTROCARDIOGRAPHY , *TELEMEDICINE , *SURGICAL complications , *ARRHYTHMIA , *IMPLANTABLE cardioverter-defibrillators , *FLECAINIDE , *PATIENT monitoring , *MEDICAL thermometry , *SYMPTOMS - Abstract
Introduction: Patients with Brugada syndrome (BrS) face an increased risk of ventricular arrhythmias and sudden cardiac death. Implantable cardiac monitors (ICMs) have emerged as effective tools for detecting arrhythmias in BrS. Technological advancements, including temperature sensors and improved subcutaneous electrocardiogram (subECG) signal quality, hold promise for further enhancing their utility in this population. Methods and results: We present a case of a 40‐year‐old man exhibiting a BrS type 2 pattern on 12‐lead ECG, who underwent ICM insertion (BIOMONITOR IIIm, BIOTRONIK) due to drug‐induced BrS type 1 pattern and a history of syncope, with a negative response to programmed ventricular stimulation. The device contains an integrated temperature sensor and can transmit daily vital data, such as mean heart rate and physical activity. Several months later, remote alerts indicated a temperature increase, along with transmitted subECGs suggesting a fever‐induced BrS type 1 pattern. The patient was promptly advised to commence antipyretic therapy. Over the following days, remotely monitored parameters showed decreases in mean temperature, physical activity, and mean heart rate, without further recurrence of abnormal subECGs. Conclusion: ICMs offer valuable insights beyond arrhythmia detection in BrS. Early detection of fever using embedded temperature sensors may improve patient management, while continuous subECG morphological analysis has the potential to enhance risk stratification in BrS patients. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
13. Wide QRS tachycardia in a patient with atrial fibrillation: a case report and approach to diagnosis.
- Author
-
Shaikh, Mohammad, Golzarian, Hafez, and Hakim, Fayaz A
- Subjects
ATRIAL fibrillation ,ATRIAL flutter ,TACHYCARDIA ,VENTRICULAR tachycardia ,DIAGNOSIS ,MYOCARDIAL depressants - Abstract
Background Wide QRS complex (QRS) tachycardia in patients with atrial fibrillation (AF) or atrial flutter treated with antiarrhythmic drugs can occur for a variety of reasons and needs careful evaluation for appropriate management of the patient. Case summary We report a case of wide QRS complex tachycardia in a patient with AF treated with Flecainide who received multiple external cardioversion attempts for a presumed diagnosis of ventricular tachycardia. Intravenous Diltiazem and an oral beta-blocker led to the resolution of wide QRS complex tachycardia. Discussion Wide QRS tachycardia due to pro-arrhythmic effect or rate-dependency phenomenon of antiarrhythmic agents should be included in the differentials. In this brief report, we discuss the differential diagnosis and outline a practical approach for acute and long-term management of these patients. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
14. Many human pharmaceuticals are weak inhibitors of the cytochrome P450 system in rainbow trout (Oncorhynchus mykiss) liver S9 fractions.
- Author
-
Pihlaja, Tea, Oksanen, Timo, Vinkvist, Netta, and Sikanen, Tiina
- Subjects
RAINBOW trout ,CYTOCHROME P-450 ,FLECAINIDE ,DISULFIRAM ,BIMATOPROST - Abstract
Introduction: Pharmaceutical residues are widely detected in aquatic environment and can be taken up by nontarget species such as fish. The cytochromes P450 (CYP) represent an important detoxification mechanism in fish, like in humans. In the present study, we assessed the correlation of the substrate selectivities of rainbow trout CYP1A and CYP3A homologues with those of human, through determination of the half-maximal inhibitory concentrations (IC50) of a total sixteen human pharmaceuticals toward CYP1A-like ethoxyresorufin O-deethylase (EROD) and CYP3A-like 7-benzyloxy-4-trifluoromethylcoumarin O-debenzylase (BFCOD) in rainbow trout (Oncorhynchus mykiss) liver S9 fractions (RT-S9). Methods: The inhibitory impacts (IC50) of atomoxetine, atorvastatin, azelastine, bimatoprost, clomethiazole, clozapine, desloratadine, disulfiram, esomeprazole, felbinac, flecainide, orphenadrine, prazosin, quetiapine, sulpiride, and zolmitriptan toward the EROD and BFCOD activities in RT-S9 were determined using the IC50 shift assay, capable of identifying time-dependent inhibitors (TDI). Additionally, the nonspecific binding of the test pharmaceuticals to RT-S9 was assessed using equilibrium dialysis. Results: Most test pharmaceuticals were moderate to weak inhibitors of both EROD and BFCOD activity in RT-S9, even if most are noninhibitors of human CYP1A or CYP3A. Only bimatoprost, clomethiazole, felbinac, sulpiride, and zolmitriptan did not inhibit either activity in RT-S9. EROD inhibition was generally stronger than that of BFCOD and some substances (atomoxetine, flecainide, and prazosin) inhibited selectively only EROD activity. The strongest EROD inhibition was detected with azelastine and esomeprazole (unbound IC50 of 3.8 ± 0.5 µM and 3.0 ± 0.8 µM, respectively). None of the test substances were TDIs of BFCOD, but esomeprazole was a TDI of EROD. Apart from clomethiazole and disulfiram, the nonspecific binding of the test pharmaceuticals to the RT-S9 was extensive (unbound fractions <0.5) and correlated well (R2 = 0.7135) with their water-octanol distribution coefficients. Discussion: The results indicate that the P450 interactions in RT-S9 cannot be explicitly predicted based on human data, but the in vitro data reported herein can shed light on the substrate selectivity of rainbow trout CYP1A1 and CYP3A27 in comparison to their human homologues. The IC50 concentrations are however many orders of magnitude higher than average environmental concentrations of pharmaceuticals. The time-dependent EROD inhibition by esomeprazole could warrant further research to evaluate its possible interlinkages with hepatotoxic impacts on fish. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
15. Synthesis of Pharma Europa Impurity-A of Flecainide Acetate.
- Author
-
Saladi, Jyothi Sudharshan Chakradhar, Vaddi, Panduranga Rao, Chavakula, Ramadas, Bonige, Kishore Babu, and Karumanchi, Kishore
- Subjects
- *
FLECAINIDE , *ACETATES , *ARRHYTHMIA , *AMMONIUM acetate - Abstract
This article discusses the synthesis of Pharma Europa Impurity-A, a process impurity that can be formed during the preparation of Flecainide acetate, a medication used to treat cardiac dysrhythmia. The detection and control of impurities are important for obtaining regulatory approvals, and the availability of authentic specimens of compounds is necessary for their analysis. The article provides a detailed synthesis and characterization of Pharma Europa Impurity-A, which will aid in ensuring the purity of the manufactured drug. The authors acknowledge the support of Aurobindo Pharma Limited in conducting this research. [Extracted from the article]
- Published
- 2024
- Full Text
- View/download PDF
16. Wolff-Parkinson-White Syndrome in the Preterm Neonate.
- Author
-
Jadczak, Elizabeth A. and Jnah, Amy J.
- Subjects
WOLFF-Parkinson-White syndrome treatment ,INTERVERTEBRAL disk abnormalities ,EDUCATION of parents ,CESAREAN section ,PROPRANOLOL ,WOLFF-Parkinson-White syndrome ,PHYSIOLOGIC salines ,RARE diseases ,NEONATAL intensive care units ,SUPRAVENTRICULAR tachycardia ,EVALUATION of medical care ,NEONATAL intensive care ,AMIODARONE ,ADRENALINE ,HYDROCORTISONE ,DISCHARGE planning ,HEART conduction system ,HYPOCALCEMIA ,FETAL heart rate ,FLECAINIDE ,HYDROPS fetalis ,ACYCLIC acids ,VITAMIN D ,SYMPTOMS - Abstract
Wolff-Parkinson-White (WPW) syndrome is a rare cardiac condition arising from abnormal embryologic development of the annulus fibrosus in combination with the cardiac conduction system. The abnormality results in the development of accessory pathways and preexcitation changes which can provoke episodes of tachyarrhythmias. The most common presentation of WPW syndrome is supraventricular tachycardia. Beyond customary abortive therapy, chronic management strategies vary based upon timing and clinical severity of the initial disease presentation. Prompt diagnosis and rate control have a dramatic impact on the outcomes of morbidity and mortality. The purpose of this article is to present a case study of a preterm infant who manifested with WPW syndrome. Additionally, the article will explore the pathophysiology of WPW syndrome and the timing and presentation of common clinical manifestations of the disease, along with current diagnostic and treatment strategies to achieve optimal patient outcomes in the neonatal population. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
17. Flecainide Is Associated With a Lower Incidence of Arrhythmic Events in a Large Cohort of Patients With Catecholaminergic Polymorphic Ventricular Tachycardia.
- Author
-
Bergeman, Auke, Lieve, Krystien, Kallas, Dania, Bos, J, Rosés I Noguer, Ferran, Denjoy, Isabelle, Zorio, Esther, Kammeraad, Janneke, Peltenburg, Puck, Tobert, Katie, Aiba, Takeshi, Atallah, Joseph, Drago, Fabrizio, Batra, Anjan, Brugada, Ramon, Borggrefe, Martin, Clur, Sally-Ann, Cox, Moniek, Davis, Andrew, Dhillon, Santokh, Etheridge, Susan, Fischbach, Peter, Franciosi, Sonia, Haugaa, Kristina, Horie, Minoru, Johnsrude, Christopher, Kane, Austin, Krause, Ulrich, Kwok, Sit-Yee, LaPage, Martin, Ohno, Seiko, Probst, Vincent, Roberts, Jason, Robyns, Tomas, Sacher, Frederic, Semsarian, Christopher, Skinner, Jonathan, Swan, Heikki, Tavacova, Terezia, Tisma-Dupanovic, Svjetlana, Tfelt-Hansen, Jacob, Yap, Sing-Chien, Kannankeril, Prince, Leenhardt, Antoine, Till, Janice, Sanatani, Shubhayan, Tanck, Michael, Ackerman, Michael, Wilde, Arthur, and van der Werf, Christian
- Subjects
catecholaminergic polymorphic ventricular tachycardia ,sudden cardiac death ,ventricular arrhythmias ,Female ,Humans ,Adolescent ,Male ,Flecainide ,Incidence ,Cross-Over Studies ,Tachycardia ,Ventricular ,Adrenergic beta-Antagonists ,Defibrillators ,Implantable ,Death ,Sudden ,Cardiac - Abstract
BACKGROUND: In severely affected patients with catecholaminergic polymorphic ventricular tachycardia, beta-blockers are often insufficiently protective. The purpose of this study was to evaluate whether flecainide is associated with a lower incidence of arrhythmic events (AEs) when added to beta-blockers in a large cohort of patients with catecholaminergic polymorphic ventricular tachycardia. METHODS: From 2 international registries, this multicenter case cross-over study included patients with a clinical or genetic diagnosis of catecholaminergic polymorphic ventricular tachycardia in whom flecainide was added to beta-blocker therapy. The study period was defined as the period in which background therapy (ie, beta-blocker type [beta1-selective or nonselective]), left cardiac sympathetic denervation, and implantable cardioverter defibrillator treatment status, remained unchanged within individual patients and was divided into pre-flecainide and on-flecainide periods. The primary end point was AEs, defined as sudden cardiac death, sudden cardiac arrest, appropriate implantable cardioverter defibrillator shock, and arrhythmic syncope. The association of flecainide with AE rates was assessed using a generalized linear mixed model assuming negative binomial distribution and random effects for patients. RESULTS: A total of 247 patients (123 [50%] females; median age at start of flecainide, 18 years [interquartile range, 14-29]; median flecainide dose, 2.2 mg/kg per day [interquartile range, 1.7-3.1]) were included. At baseline, all patients used a beta-blocker, 70 (28%) had an implantable cardioverter defibrillator, and 21 (9%) had a left cardiac sympathetic denervation. During a median pre-flecainide follow-up of 2.1 years (interquartile range, 0.4-7.2), 41 patients (17%) experienced 58 AEs (annual event rate, 5.6%). During a median on-flecainide follow-up of 2.9 years (interquartile range, 1.0-6.0), 23 patients (9%) experienced 38 AEs (annual event rate, 4.0%). There were significantly fewer AEs after initiation of flecainide (incidence rate ratio, 0.55 [95% CI, 0.38-0.83]; P=0.007). Among patients who were symptomatic before diagnosis or during the pre-flecainide period (n=167), flecainide was associated with significantly fewer AEs (incidence rate ratio, 0.49 [95% CI, 0.31-0.77]; P=0.002). Among patients with ≥1 AE on beta-blocker therapy (n=41), adding flecainide was also associated with significantly fewer AEs (incidence rate ratio, 0.25 [95% CI, 0.14-0.45]; P
- Published
- 2023
18. Pharmacogenetic Study of Antiarrhythmic Drugs for Atrial Fibrillation
- Author
-
Medtronic and Dawood Darbar, MD, Professor of Medicine
- Published
- 2023
19. Acute Management of Paroxysmal Atrial Fibrillation with Intravenous Flecainide plus Oral Beta-Blockers
- Author
-
Athanasios Kartalis, Dimitrios Afendoulis, Petros Voutas, Maria Moutafi, Nikolaos Papagiannis, Stefanos Garoufalis, Nikolaos Kartalis, Nikolaos Smyrnioudis, Antonios Ziakas, and Matthaios Didagelos
- Subjects
flecainide ,b-blocker ,atrial fibrillation ,paroxysmal ,cardioversion ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Background: Intravenous (IV) flecainide is recommended for the pharmacological cardioversion of recent-onset atrial fibrillation (AF). The aim of this study was to study the efficacy and safety of IV flecainide, co-administered with oral b-blockers, for the cardioversion of paroxysmal AF. Methods: Single-center registry, initiated in the “Skylitseion” General Hospital of Chios in January 2020. The main inclusion criterion was IV flecainide administration plus oral b-blocker for recent-onset AF (≤48 h). The primary outcome was conversion to sinus rhythm at 2 h. Results: A total of 121 (73 males and 48 females, with mean age 61.4 years) consecutive, unselected patients who complied with the study protocol were included. A successful conversion to sinus rhythm at 2 h was achieved in 99 patients (success rate: 81.8%). The median conversion time was 11.7 min (varied from 3 to 23 min). Duration of hospitalization was significantly shorter in patients who were successfully cardioverted with IV flecainide (10.9 vs. 30.7 h, p < 0.001). No serious adverse events were recorded. Conclusion: This is one of the largest registries worldwide, evaluating the effectiveness and safety of IV flecainide co-administered with a b-blocker in the acute management of recent-onset AF. The successful conversion rate at 2 h is very high and quick with no serious adverse events.
- Published
- 2024
- Full Text
- View/download PDF
20. Neonatal Near Fatal Flecainide Toxicity
- Author
-
Fatma Mohammed Abdullah Al Balushi, Said Al-Hinshi, Anita Tandon, Ziad Kazzi, Badria Alhatali, and Fatma Mohammed AL Balushi
- Subjects
flecainide ,overdose ,sodium bicarbonate ,vt ,Medicine - Abstract
Background: Flecainide is an anti-arrhythmic medication with a narrow therapeutic index and a high mortality rate, when overdosed. Few cases of flecainide toxicity in neonates and children due to medication error have been reported in the literature. A case of an accidental flecainide overdose in a neonate in Oman was presented. Case Presentation: A 19-day-old newborn girl developed persistent supra ventricular tachycardia (SVT) after receiving nebulized albuterol for acute bronchitis. After unsuccessful treatment with adenosine, she was given flecainide 5.6 mg orally every 24 hours for resolution of the SVT. On day four of admission, the child inadvertently received 100 mg of flecainide orally due to a dose calculation error. The child developed wide complex tachyarrhythmia followed by pulseless ventricular tachycardia (VT) requiring cardiopulmonary resuscitation. Sodium bicarbonate IV bolus followed by an infusion was administered. The patient developed two additional episodes of pulseless VT that coincided temporally with two interruptions of the sodium bicarbonate infusion, and required high dose of inotropic support. The patient developed convulsions but her brain ultrasound was normal. Her condition stabilized on day three after the toxicity occurred. Repeated echo showed a normal EF. The patient was discharged on propranolol and levetiracetam and was doing well on outpatient follow up. Conclusion: Flecainide is a potentially lethal medication in overdose due to its sodium channel blocking properties. Sodium bicarbonate remains an essential component of treatment. [SJEMed 2024; 5(1.000): 049-054]
- Published
- 2024
- Full Text
- View/download PDF
21. Acute Management of Paroxysmal Atrial Fibrillation with Intravenous Flecainide plus Oral Beta-Blockers.
- Author
-
Kartalis, Athanasios, Afendoulis, Dimitrios, Voutas, Petros, Moutafi, Maria, Papagiannis, Nikolaos, Garoufalis, Stefanos, Kartalis, Nikolaos, Smyrnioudis, Nikolaos, Ziakas, Antonios, and Didagelos, Matthaios
- Subjects
- *
ATRIAL fibrillation , *FLECAINIDE , *ORAL drug administration , *ADRENERGIC beta blockers , *ELECTRIC countershock - Abstract
Background: Intravenous (IV) flecainide is recommended for the pharmacological cardioversion of recent-onset atrial fibrillation (AF). The aim of this study was to study the efficacy and safety of IV flecainide, co-administered with oral b-blockers, for the cardioversion of paroxysmal AF. Methods: Single-center registry, initiated in the "Skylitseion" General Hospital of Chios in January 2020. The main inclusion criterion was IV flecainide administration plus oral b-blocker for recent-onset AF (≤48 h). The primary outcome was conversion to sinus rhythm at 2 h. Results: A total of 121 (73 males and 48 females, with mean age 61.4 years) consecutive, unselected patients who complied with the study protocol were included. A successful conversion to sinus rhythm at 2 h was achieved in 99 patients (success rate: 81.8%). The median conversion time was 11.7 min (varied from 3 to 23 min). Duration of hospitalization was significantly shorter in patients who were successfully cardioverted with IV flecainide (10.9 vs. 30.7 h, p < 0.001). No serious adverse events were recorded. Conclusion: This is one of the largest registries worldwide, evaluating the effectiveness and safety of IV flecainide co-administered with a b-blocker in the acute management of recent-onset AF. The successful conversion rate at 2 h is very high and quick with no serious adverse events. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
22. Cardiac monoamine oxidase-A inhibition protects against catecholamine-induced ventricular arrhythmias via enhanced diastolic calcium control.
- Author
-
Shi, Qian, Malik, Hamza, Crawford, Rachel M, Streeter, Jennifer, Wang, Jinxi, Huo, Ran, Shih, Jean C, Chen, Biyi, Hall, Duane, Abel, E Dale, Song, Long-Sheng, and Anderson, Ethan J
- Subjects
- *
VENTRICULAR arrhythmia , *SEROTONIN uptake inhibitors , *PHOSPHOLAMBAN , *VENTRICULAR tachycardia , *FLECAINIDE , *RYANODINE receptors , *MYOCARDIAL depressants - Abstract
Aims A mechanistic link between depression and risk of arrhythmias could be attributed to altered catecholamine metabolism in the heart. Monoamine oxidase-A (MAO-A), a key enzyme involved in catecholamine metabolism and longstanding antidepressant target, is highly expressed in the myocardium. The present study aimed to elucidate the functional significance and underlying mechanisms of cardiac MAO-A in arrhythmogenesis. Methods and results Analysis of the TriNetX database revealed that depressed patients treated with MAO inhibitors had a lower risk of arrhythmias compared with those treated with selective serotonin reuptake inhibitors. This effect was phenocopied in mice with cardiomyocyte-specific MAO-A deficiency (cMAO-Adef), which showed a significant reduction in both incidence and duration of catecholamine stress-induced ventricular tachycardia compared with wild-type mice. Additionally, cMAO-Adef cardiomyocytes exhibited altered Ca2+ handling under catecholamine stimulation, with increased diastolic Ca2+ reuptake, reduced diastolic Ca2+ leak, and diminished systolic Ca2+ release. Mechanistically, cMAO-Adef hearts had reduced catecholamine levels under sympathetic stress, along with reduced levels of reactive oxygen species and protein carbonylation, leading to decreased oxidation of Type II PKA and CaMKII. These changes potentiated phospholamban (PLB) phosphorylation, thereby enhancing diastolic Ca2+ reuptake, while reducing ryanodine receptor 2 (RyR2) phosphorylation to decrease diastolic Ca2+ leak. Consequently, cMAO-Adef hearts exhibited lower diastolic Ca2+ levels and fewer arrhythmogenic Ca2+ waves during sympathetic overstimulation. Conclusion Cardiac MAO-A inhibition exerts an anti-arrhythmic effect by enhancing diastolic Ca2+ handling under catecholamine stress. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
23. Incidence of All-Cause, Cardiovascular, and Atrial Fibrillation-Related Hospitalizations
- Author
-
Danilo Menichelli, MD, Pasquale Pignatelli, MD, PhD, Tommaso Brogi, MD, Arianna Pannunzio, MD, Francesco Violi, MD, Gregory Y.H. Lip, MD, Daniele Pastori, MD, Tiziana Di Stefano, Elio Sabbatini, Patrizia Iannucci, Alberto Befani, Ilaria Maria Palumbo, and Emanuele Valeriani
- Subjects
amiodarone ,antiarrhythmic ,atrial fibrillation ,digoxin ,flecainide ,hospitalization ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Background: Atrial fibrillation (AF) is associated with an increased risk of hospital admission, but few data on reasons for hospitalization and on the role of anti-arrhythmic drugs are available. Objectives: The purpose of this study was to investigate the incidence rate and factors associated with all-cause, cardiovascular, and AF-related hospitalizations. Methods: Prospective ongoing ATHERO-AF (Atherosclerosis in Atrial Fibrillation) cohort study enrolling AF patients on oral anticoagulants. Primary end points were all-cause, cardiovascular, and AF-related hospitalization, the latter defined as AF recurrences for paroxysmal AF and high-rate symptomatic AF episodes for persistent/permanent AF patients. Results: 2,782 patients were included (43.5% female; mean age was 74.6 ± 9.1 years). During a mean follow-up of 31 ± 26.8 months, 1,205 (12.1%/year) all-cause, 533 cardiac (5.7%/year), and 180 (2.0%/year) AF-related hospitalizations occurred. Predictors of AF-related hospitalizations were the use of flecainide/propafenone in both paroxysmal and persistent/permanent AF patients (HR: 1.861; 95% CI: 1.116 to 3.101 and 1.947; 95% CI: 1.069 to 3.548, respectively). Amiodarone (HR: 3.012; 95% CI: 1.835-4.943), verapamil/diltiazem (HR: 2.067; 95% CI: 1.117-3.825), and cancer (HR: 1.802; 95% CI: 1.057-3.070) but not beta-blockers and digoxin were associated with an increased risk of AF-related hospitalizations in persistent/permanent AF patients. Conclusions: Elderly AF patients frequently undergo hospitalizations for both cardiovascular and noncardiovascular causes. The use of anti-arrhythmic drugs was associated with an increased risk of AF-related hospitalization suggesting a scarce effect of these drugs in preventing AF episodes. Therefore, their use should be carefully considered and reserved for symptomatic patients with frequent AF recurrences.
- Published
- 2024
- Full Text
- View/download PDF
24. Contact allergy to subcutaneous implantable cardioverter defibrillator in a child with Brugada syndrome.
- Author
-
Ciriello, Giovanni Domenico, Colonna, Diego, Correra, Anna, Romeo, Emanuele, Russo, Maria Giovanna, and Sarubbi, Berardo
- Subjects
- *
CONTACT dermatitis diagnosis , *PROSTHESIS-related infections , *BRUGADA syndrome , *RARE diseases , *DIAGNOSTIC errors , *COBALT , *IMPLANTABLE cardioverter-defibrillators , *MAGNETIC resonance angiography , *FLECAINIDE , *CARDIAC arrest , *ECHOCARDIOGRAPHY , *CHILDREN ,BRUGADA syndrome diagnosis - Abstract
Allergic reactions to components of cardiac implantable electronic devices are rare and often go undiagnosed, which can lead to a misdiagnosis of device infection. Contact allergy to subcutaneous implantable cardioverter defibrillator (S‐ICD) is extremely rare. In this report, we present a case of cobalt‐related contact allergy in a pediatric patient with Brugada syndrome who underwent S‐ICD implantation. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
25. Predictive Factors to Effectively Terminate Paroxysmal Atrial Fibrillation by Blocking Atrial Selective Ionic Currents (SELECTCARFAP)
- Author
-
Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III and David Filgueiras-Rama, MD PhD
- Published
- 2023
26. A Prospective Study of Medical Therapy Against Cryoballoon Ablation in Symptomatic Recent Onset Persistent AF (METACSA)
- Published
- 2023
27. First-line Cryoablation for Early Treatment of Persistent Atrial Fibrillation
- Author
-
The Swedish Research Council, Erling-Persson Stiftelse, Swedish Heart Lung Foundation, Uppsala University, and Carina Blomstrom Lundqvist, MD, PhD, Senior Consultant, Professor
- Published
- 2023
28. Elimination of VPB With Ablation Versus Anti-arrhythmic Drug Treatment (ECTOPIA)
- Published
- 2023
29. Flecainide in Treating Patients With Chronic Neuropathic Pain
- Author
-
National Cancer Institute (NCI) and Group Chair
- Published
- 2023
30. Catecholaminergic Polymorphic Ventricular Tachycardia: Clinical Characteristics, Diagnostic Evaluation and Therapeutic Strategies.
- Author
-
Aggarwal, Abhinav, Stolear, Anton, Alam, Md Mashiul, Vardhan, Swarnima, Dulgher, Maxim, Jang, Sun-Joo, and Zarich, Stuart W.
- Subjects
- *
VENTRICULAR tachycardia , *BRUGADA syndrome , *VENTRICULAR arrhythmia , *CARDIAC arrest , *ARRHYTHMIA , *IMPLANTABLE cardioverter-defibrillators , *RYANODINE receptors - Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a severe hereditary arrhythmia syndrome predominantly affecting children and young adults. It manifests through bidirectional or polymorphic ventricular arrhythmia, often culminating in syncope triggered by physical exertion or emotional stress which can lead to sudden cardiac death. Most cases stem from mutations in the gene responsible for encoding the cardiac ryanodine receptor (RyR2), or in the Calsequestrin 2 gene (CASQ2), disrupting the handling of calcium ions within the cardiac myocyte sarcoplasmic reticulum. Diagnosing CPVT typically involves unmasking the arrhythmia through exercise stress testing. This diagnosis emerges in the absence of structural heart disease by cardiac imaging and with a normal baseline electrocardiogram. Traditional first-line treatment primarily involves β-blocker therapy, significantly reducing CPVT-associated mortality. Adjunctive therapies such as moderate exercise training, flecainide, left cardiac sympathetic denervation and implantable cardioverter-defibrillators have been utilized with reasonable success. However, the spectrum of options for managing CPVT has expanded over time, demonstrating decreased rates of arrhythmic events. Furthermore, ongoing research into potential new therapies including gene therapies has the potential to further enhance treatment paradigms. This review aims to succinctly encapsulate the contemporary understanding of the clinical characteristics, diagnostic approach, established therapeutic interventions and the promising future directions in managing CPVT. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
31. Are antiarrhythmic agents indicated in premature ventricular complex‐induced cardiomyopathy and when?
- Author
-
Kantharia, Bharat K. and Shah, Arti N.
- Subjects
- *
PATIENT selection , *CARDIOMYOPATHIES , *PATIENT safety , *TREATMENT effectiveness , *CALCIUM antagonists , *AMIODARONE , *ARRHYTHMIA , *MEXILETINE , *DRUG efficacy , *ADRENERGIC beta blockers , *FLECAINIDE , *CATHETER ablation , *MYOCARDIAL depressants , *PROPAFENONE , *DISEASE complications - Abstract
Introduction: Premature ventricular complexes (PVCs) are the most common ventricular arrhythmia that are encountered in the clinical practice. Recent data suggests that high PVC burden may lead to the development of PVC‐induced cardiomyopathy (PVC‐CM) even in patients without structural heart disease. Treatment for effective suppression of PVCs, can reverse PVC‐CM. Both antiarrhythmic drugs (AADs) and catheter ablation (CA) are recognized treatment modalities for any cardiac arrhythmias. However, with increasing preference of CA, the role of AADs needs further defining regarding their efficacy, safety, indications and patient selection to treat PVC‐CM. Methods: To ascertain the role of AADs to treat PVC‐CM; whether they are indicated to treat PVC‐CM, and if so, when, we interrogated PubMed and other search engines for English language publications with key words premature ventricular complexes (PVCs), cardiomyopathy, anti‐arrhythmic drugs, catheter ablation, and pharmacological agents. All publications were carefully reviewed and scrutinized by the authors for their inclusion in the review paper. For illustration of cases, ethical standard was observed as per the 1975 Declaration of Helsinki, and the patient was treated as per the prevailing standard of care. Informed consent was obtained from the patient for conducting the ablation procedure. Results: Our literature search specifically the pharmacological treatment of PVC‐CM with AADs revealed significant paradigm shift in treatment approach for PVCs and PVC‐induced cardiomyopathy. No major large, randomized control trials of AADs versus CA for PVC‐CM were found. We found that beta‐blockers and calcium channel blockers are particularly effective in the treatment of PVCs originating from right ventricular outflow tract. For Class Ic AADs ‐ flecainide and propafenone, small clinical studies showed Class Ic AADs to be effective in PVC suppression, but their usage was not recommended in patients with significant coronary artery disease. Mexiletine was found to have modest effect on PVC suppression. Studies showed sotalol to significantly reduce PVCs frequency in patients receiving both low and high doses. Studies also showed amiodarone to have higher successful PVC suppression, but not recommended as a first‐line treatment for patients with idiopathic PVCs in the absence of symptoms and left ventricular dysfunction. For dronedarone, no major clinical data were available. Conclusions: Based on the available data in the literature, we conclude that AADs play important role in the treatment of PVC‐induced cardiomyopathy. However, appropriate patient selection criteria are vitally important, and in general terms AADs are indicated or polymorphic PVCs, epicardial PVCs; and when CA procedure is contraindicated, or not feasible or failed. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
32. Evidence of exposure to flecainide in a newborn by keratinous matrices testing and interpretation of the findings.
- Author
-
Arbouche, Nadia, Raul, Jean‐Sébastien, and Kintz, Pascal
- Abstract
Pediatric poisoning represents a serious problem all around the world. Abuse or neglect of children by adults must be highlighted in children exposed to drugs to which they would not normally have access. Usually, segmental hair analysis would allow in these contexts to determine whether the exposure was unique or repetitive. Hair and nail samples from a 9‐month‐old girl were received in our laboratory for analysis, after the child was hospitalized due to severe dehydration caused by her mother's neglect. At the admission, flecainide, an antiarrhythmic never prescribed to the child, was identified in the daughter urine. Using an LC–MS/MS method, flecainide tested positive in the child's hair at the following concentrations: 66 pg/mg (root to 1 cm), 61 pg/mg (1–2 cm), and 125 pg/mg (2–3 cm). Traces below the limit of quantification (1 pg/mg) were also present in the nail clippings. These concentrations are much lower than those obtained in adults under daily treatment. Given the different pharmacokinetic and dynamic parameters in children, the different rate of hair growth, and the greater porosity of the hair, which makes it more prone to external contamination, the interpretation of hair findings in children remains very complicated. In this case, it can be assumed that the presence of the drug in the urine indicates systemic incorporation and that administration had occurred for some months (three positive segments). The interpretation of hair tests from young children needs a global review of all the findings, as a positive result cannot stand alone to claim repetitive exposures. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
33. Effect of Flecainide and Ibutilide Alone and in Combination to Terminate and Prevent Recurrence of Atrial Fibrillation.
- Author
-
Burashnikov, Alexander, Di Diego, José M., Patocskai, Bence, Echt, Debra S., Belardinelli, Luiz, and Antzelevitch, Charles
- Abstract
BACKGROUND: There is a need for improved approaches to rhythm control therapy of atrial fibrillation (AF). METHODS: The effectiveness of flecainide (1.5 µmol/L) and ibutilide (20 nmol/L), alone and in combination, to cardiovert and prevent AF recurrence was studied in canine-isolated coronary--perfused right atrioventricular preparations. We also examined the safety of the combination of flecainide (1.5 µmol/L) and ibutilide (50 nmol/L) using canine left ventricular wedge preparations. RESULTS: Sustained AF (>1 hour) was inducible in 100%, 60%, 20%, and 0% of atria in the presence of acetylcholine alone, acetylcholine+ibutilide, acetylcholine+flecainide, and acetylcholine+ibutilide+flecainide, respectively. When used alone, flecainide and ibutilide cardioverted sustained AF in 40% and 20% of atria, respectively, but in 100% of atria when used in combination. Ibutilide prolonged atrial and ventricular effective refractory period by 15% and 8%, respectively, at a cycle length of 500 ms (P<0.05 for both). Flecainide increased the effective refractory period in atria by 27% (P<0.01) but by only 2% in the ventricles. The combination of the 2 drugs lengthened the effective refractory period by 42% in atria (P<0.01) but by only 7% (P<0.05) in the ventricles. In left ventricular wedges, ibutilide prolonged QT and Tpeak-Tend intervals by 25 and 55%, respectively (P<0.05 for both; cycle length, 2000 ms). The addition of flecainide (1.5 µmol/L) partially reversed these effects (P<0.05 for both parameters versus ibutilide alone). Torsades de Pointes score was relatively high with ibutilide alone and low with the drug combination. CONCLUSIONS: In our experimental model, a combination of flecainide and ibutilide significantly improves cardioversion and prevents the recurrence of AF compared with monotherapies with little to no risk for the development of long-QT--mediated ventricular proarrhythmia. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
34. Flecainide Versus Amiodarone in the Cardioversion of Paroxysmal Atrial Fibrillation at the Emergency Department, in Patients With Coronary Artery Disease Without Residual Ischemia (FLECA-ED)
- Author
-
Win Medica, Pharmassist Ltd, and Konstantinos Tsioufis, Principal Investigator. Prof. Konstantinos P. Tsioufis, MD, PhD, FESC, FACC, Professor of Cardiology, Director of 1st Department of Cardiology, Hippokratio Hospital, University of Athens
- Published
- 2023
35. Early Aggressive Invasive Intervention for Atrial Fibrillation (EARLY-AF)
- Author
-
Ottawa Heart Institute Research Corporation, Medtronic, Baylis Medical Company, and Jason Andrade, MD
- Published
- 2022
36. Rediscover the predictive capacity of B-type natriuretic peptide applied to neonatal supraventricular tachycardia.
- Author
-
Lu, Yaheng, Xiong, Ying, Wen, Yizhou, Yang, Yanfeng, and Liu, Hanmin
- Subjects
SUPRAVENTRICULAR tachycardia ,PEPTIDES ,RECEIVER operating characteristic curves ,FLECAINIDE ,MYOCARDIAL depressants ,HEART failure - Abstract
Background: Supraventricular tachycardia (SVT) is one of the most common non-benign arrhythmias in neonates, potentially leading to cardiac decompensation. This study investigated the early risk factors of acute heart failure (AHF) secondary to SVT in neonates, and explored their value in guiding the selection of effective anti-arrhythmic treatment. Methods: A total of 43 newborns diagnosed with and treated for SVT between January 2017 and December 2022 were analyzed. According to the presence of AHF after restoring sinus rhythm in newborns with SVT, they were divided into SVT with AHF group and SVT without AHF group. Clinical data and anti-arrhythmic therapies were analyzed. Risk factors of AHF secondary to SVT in neonates were determined using logistic regression. The cut-off value for predictors of AHF secondary to SVT and demanding of a second-line anti-arrhythmic treatment was determined through receiver operating characteristic (ROC) analysis. Results: Time to initial control of tachycardia > 24 h, hyperkalemia, anemia, and plasma B-type natriuretic peptide (BNP) were identified as risk factors of AHF secondary to SVT in neonates. BNP exhibited AUC of 0.80 in predicting AHF, and BNP > 2460.5pg/ml (OR 2.28, 95% CI 1.27 ~ 45.39, P = 0.03) was an independent predictor, yielding sensitivity of 70.6% and specificity of 84.6%. Neonates with BNP > 2460.5pg/ml (37.5% versus 7.4%, P = 0.04) had a higher demand for a second line anti-arrhythmic treatment to terminate SVT, with sensitivity and specificity for BNP in predicting at 75.0%, 71.4%, respectively. Conclusions: BNP could be used to predict an incident of AHF secondary to SVT and a demand of second-line anti-arrhythmic treatment to promptly terminate SVT and prevent decompensation in neonates. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
37. Medical cardioversion of atrial fibrillation and flutter with class IC antiarrhythmic drugs in young patients with and without congenital heart disease.
- Author
-
Przybylski, Robert, Eberly, Logan M., Alexander, Mark E., Bezzerides, Vassilios J., DeWitt, Elizabeth S., Dionne, Audrey, Mah, Douglas Y., Triedman, John K., Walsh, Edward P., and O'Leary, Edward T.
- Subjects
- *
MYOCARDIAL depressants , *DRUG efficacy , *STATISTICS , *CONFIDENCE intervals , *ORAL drug administration , *ATRIAL fibrillation , *ATRIAL flutter , *FLECAINIDE , *PROPAFENONE , *CONGENITAL heart disease , *RETROSPECTIVE studies , *MANN Whitney U Test , *FISHER exact test , *LONG QT syndrome , *DISEASE incidence , *VENTRICULAR dysfunction , *DESCRIPTIVE statistics , *KAPLAN-Meier estimator , *ELECTROCARDIOGRAPHY , *RESEARCH funding , *DATA analysis , *DRUG side effects , *LONGITUDINAL method , *PROPORTIONAL hazards models , *ADULTS , *ADOLESCENCE - Abstract
Introduction: The use of flecainide and propafenone for medical cardioversion of atrial fibrillation (AF) and atrial flutter/intra‐atrial reentrant tachycardia (IART) is well‐described in adults without congenital heart disease (CHD). Data are sparse regarding their use for the same purpose in adults with CHD and in adolescent patients with anatomically normal hearts and we sought to describe the use of class IC drugs in this population and identify factors associated with decreased likelihood of success. Methods: Single center retrospective cohort study of patients who received oral flecainide or propafenone for medical cardioversion of AF or IART from 2000 to 2022. The unit of analysis was each episode of AF/IART. We performed a time‐to‐sinus rhythm analysis using a Cox proportional hazards model clustering on the patient to identify factors associated with increased likelihood of success. Results: We identified 45 episodes involving 41 patients. As only episodes of AF were successfully cardioverted with medical therapy, episodes of IART were excluded from our analyses. Use of flecainide was the only factor associated with increased likelihood of success. There was a statistically insignificant trend toward decreased likelihood of success in patients with CHD. Conclusions: Flecainide was more effective than propafenone. We did not detect a difference in rate of conversion to sinus rhythm between patients with and without CHD and were likely underpowered to do so, however, there was a trend toward decreased likelihood of success in patients with CHD. That said, medical therapy was effective in >50% of patients with CHD with AF. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
38. Management of refractory intramural left ventricular summit ventricular arrhythmia: Acute success using bipolar radiofrequency catheter ablation with recurrence.
- Author
-
Sudo, Koji, Kuroki, Kenji, Asakawa, Tetsuya, Aonuma, Kazutaka, and Sato, Akira
- Subjects
PATIENT aftercare ,MYOCARDIAL depressants ,ECHOCARDIOGRAPHY ,AMBULATORY electrocardiography ,ADENOSINE triphosphate ,PERICARDIUM ,ISOPROTERENOL ,CATHETER ablation ,FLECAINIDE ,VENOGRAPHY ,BODY surface mapping ,DISEASE relapse ,VENTRICULAR tachycardia ,ADRENERGIC beta blockers ,ELECTROPHYSIOLOGY ,VENTRICULAR arrhythmia ,BIOELECTRIC impedance ,ARRHYTHMIA ,ANGIOGRAPHY ,CATHETERIZATION - Published
- 2023
- Full Text
- View/download PDF
39. TNFSF14/LIGHT promotes cardiac fibrosis and atrial fibrillation vulnerability via PI3Kγ/SGK1 pathway-dependent M2 macrophage polarisation.
- Author
-
Wu, Yirong, Zhan, Siyao, Chen, Lian, Sun, Mingrui, Li, Miaofu, Mou, Xuanting, Zhang, Zhen, Xu, Linhao, and Xu, Yizhou
- Subjects
- *
HEART fibrosis , *ATRIAL fibrillation , *MYOCARDIAL depressants , *FLECAINIDE , *MONONUCLEAR leukocytes , *BLOOD proteins , *MACROPHAGES , *CARDIAC contraction - Abstract
Background: Tumour necrosis factor superfamily protein 14 (TNFSF14), also called LIGHT, is an important regulator of immunological and fibrosis diseases. However, its specific involvement in cardiac fibrosis and atrial fibrillation (AF) has not been fully elucidated. The objective of this study is to examine the influence of LIGHT on the development of myocardial fibrosis and AF. Methods: PCR arrays of peripheral blood mononuclear cells (PBMCs) from patients with AF and sinus rhythm was used to identify the dominant differentially expressed genes, followed by ELISA to evaluate its serum protein levels. Morphological, functional, and electrophysiological changes in the heart were detected in vivo after the tail intravenous injection of recombinant LIGHT (rLIGHT) in mice for 4 weeks. rLIGHT was used to stimulate bone marrow-derived macrophages (BMDMs) to prepare a macrophage-conditioned medium (MCM) in vitro. Then, the MCM was used to culture mouse cardiac fibroblasts (CFs). The expression of relevant proteins and genes was determined using qRT-PCR, western blotting, and immunostaining. Results: The mRNA levels of LIGHT and TNFRSF14 were higher in the PBMCs of patients with AF than in those of the healthy controls. Additionally, the serum protein levels of LIGHT were higher in patients with AF than those in the healthy controls and were correlated with left atrial reverse remodelling. Furthermore, we demonstrated that rLIGHT injection promoted macrophage infiltration and M2 polarisation in the heart, in addition to promoting atrial fibrosis and AF inducibility in vivo, as detected with MASSON staining and atrial burst pacing respectively. RNA sequencing of heart samples revealed that the PI3Kγ/SGK1 pathway may participate in these pathological processes. Therefore, we confirmed the hypothesis that rLIGHT promotes BMDM M2 polarisation and TGB-β1 secretion, and that this process can be inhibited by PI3Kγ and SGK1 inhibitors in vitro. Meanwhile, increased collagen synthesis and myofibroblast transition were observed in LIGHT-stimulated MCM-cultured CFs and were ameliorated in the groups treated with PI3Kγ and SGK1 inhibitors. Conclusion: LIGHT protein levels in peripheral blood can be used as a prognostic marker for AF and to evaluate its severity. LIGHT promotes cardiac fibrosis and AF inducibility by promoting macrophage M2 polarisation, wherein PI3Kγ and SGK1 activation is indispensable. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
40. Bidirectional Ventricular Tachycardia and Prominent U Waves: Look at Fingers and Muscles and Use Flecainide.
- Author
-
Oreto, Lilia, Briuglia, Silvana, Capra, Anna Paola, Ruiz, Victoria Garcia, and Di Pino, Alfredo
- Subjects
- *
ARRHYTHMIA , *VENTRICULAR tachycardia , *VENTRICULAR arrhythmia , *FLECAINIDE , *MUSCLE weakness , *MISSENSE mutation - Abstract
We present a case of bidirectional ventricular tachycardia in a 15-year-old boy asymptomatic for arrhythmias, whose major complaint was muscle weakness. At our first evaluation he was receiving sotalol for his ventricular arrhythmias. In addition to bidirectional tachycardia, electrocardiogram during sinus rhythm showed prominent U waves and prolonged QT-U interval. These electrocardiographic signs, along with the evidence of clinodactyly and mild hypertelorism, led us to the diagnosis of Andersen-Tawil syndrome, confirmed by genetic analysis that revealed a "de novo" missense mutation of KCNJ2 gene. Monotherapy with flecainide was rapidly effective and almost eliminated ventricular arrhythmias. After a 4-year follow-up there were no adverse events, flecainide has been well tolerated without significant modification of the QRS or repolarization, and ventricular arrhythmias have not been relapsed to date. The case highlights the importance of a correct clinical diagnosis, which is crucial for the optimal selection of the most appropriate drug therapy, which is expected not to be harmful, before being beneficial. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
41. Precision medicine in catecholaminergic polymorphic ventricular tachycardia: Recent advances toward personalized care.
- Author
-
Siu, Anthony, Tandanu, Edelyne, Ma, Brian, Endurance Osas, Evbayekha, Haipeng Liu, Tong Liu, Hou In Chou, Oscar, Huang, Helen, and Tse, Gary
- Subjects
- *
GENE therapy , *RISK assessment , *DIFFUSION of innovations , *VENTRICULAR tachycardia , *GENETIC variation , *ADRENERGIC beta blockers , *FLECAINIDE , *IMPLANTABLE cardioverter-defibrillators , *INDIVIDUALIZED medicine , *PHENOTYPES , *GENOTYPES , *DISEASE risk factors - Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited cardiac ion channelopathy where the initial disease presentation is during childhood or adolescent stages, leading to increased risks of sudden cardiac death. Despite advances in medical science and technology, several gaps remain in the understanding of the molecular mechanisms, risk prediction, and therapeutic management of patients with CPVT. Recent studies have identified and validated seven sets of genes responsible for various CPVT phenotypes, including RyR2, CASQ-2, TRDN, CALM1, 2, and 3, and TECRL, providing novel insights into the molecular mechanisms. However, more data on atypical CPVT genotypes are required to investigate the underlying mechanisms further. The complexities of the underlying genetics contribute to challenges in risk stratification as well as the uncertainty surrounding nongenetic modifiers. Therapeutically, although medical management involving beta-blockers and flecainide, or insertion of an implantable cardioverter defibrillator remains the mainstay of treatment, animal and stem cell studies on gene therapy for CPVT have shown promising results. However, its clinical applicability remains unclear. Current gene therapy studies have primarily focused on the RyR2 and CASQ-2 variants, which constitute 75% of all CPVT cases. Alternative approaches that target a broader population, such as CaMKII inhibition, could be more feasible for clinical implementation. Together, this review provides an update on recent research on CPVT, highlighting the need for further investigation of the molecular mechanisms, risk stratification, and therapeutic management of this potentially lethal condition. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
42. Can specific ECG markers identify a pharmacologically induced type 1 Brugada pattern? Insights from a large, single-center cohort.
- Author
-
Occhetta, Eraldo, De Vecchi, Federica, Barbonaglia, Lorella, Devecchi, Chiara, Matta, Mario, Malacrida, Maurizio, Patti, Giuseppe, and Rametta, Francesco
- Abstract
In patients with a type 2 or 3 Brugada pattern, the pharmacological (IC drugs) induction of a type 1 pattern confirms the diagnosis of Brugada syndrome. To evaluate the value of various ECG markers in predicting IC drug test results. We retrospectively analysed 443 consecutive patients referred to our Center (from January 2010 to December 2019) to undergo Ajmaline/Flecainide testing; all had a type 2 or 3 Brugada pattern or were relatives with Brugada syndrome. Clinical parameters and ECG markers (r
1 V 1 and SV 6 duration and amplitude, QRSV 1 /QRSV 6 duration, V 1 and V 2 ST amplitude) were independently evaluated for their association to pharmacological test positivity, and a logistic regression model was applied. The drug test was positive in 151 (34%) patients. On multivariate logistic regression analysis, age > 45 years, female gender, HR >60 bpm, QRSV 1 /QRSV 6 duration >1 and non-isoelectric pattern in V 2 were associated with a positive test. The percentage of patients who tested positive increased according to the presence of the above ECG markers (from 11.3% in the absence to 57.6% in the presence of both factors). During long-term follow-up, the clinical event rate was higher in patients with predictive ECG markers and very low in those without. In our population we confirmed the ability of QRSV 1 /QRSV 6 duration >1 and of a non-isoelectric pattern in V 2 to predict a pharmacologically induced type 1 Brugada pattern. Patients with neither of these ECG markers had a rather low event rate during follow-up. [ABSTRACT FROM AUTHOR]- Published
- 2023
- Full Text
- View/download PDF
43. The diagnostic and therapeutic challenge of atrial flutter in children: a case report.
- Author
-
De Nigris, Angelica, Arenella, Mattia, Di Nardo, Giangiacomo, Marco, Giovanni Maria Di, Mormile, Annunziata, Lauretta, Daria, De Simone, Caterina, Pepe, Angela, Cosimi, Rosaria, Vastarella, Rossella, Giannattasio, Antonietta, Salomone, Giovanni, Perrotta, Silverio, Cioffi, Speranza, Marzuillo, Pierluigi, Tipo, Vincenzo, and Martemucci, Luigi
- Subjects
- *
ATRIAL flutter , *FLECAINIDE , *ADRENERGIC beta blockers , *SUPRAVENTRICULAR tachycardia , *ELECTROCARDIOGRAPHY , *AMIODARONE , *CHILDREN - Abstract
Background: Palpitations represent a common cause for consultation in the pediatric Emergency Department (ED). Unlike adults, palpitations in children are less frequently dependent from the heart, recognizing other causes. Case presentation: A 11-year-old male came to our pediatric ED for epigastric pain, vomiting and palpitations. During the previous 6 month the patient was affected by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus). Electrocardiogram (ECG) revealed supraventricular tachycardia. Therefore, adenosine was administered unsuccessfully. The administration of adenosine, however, allowed us to make diagnosis of atypical atrial flutter. Multiple attempts at both electrical cardioversion, transesophageal atrial overdrive, and drug monotherapy were unsuccessful in our patient. Consequently, a triple therapy with amiodarone, flecainide, and beta-blocker was gradually designed to control the arrhythmic pattern with the restoration of a left upper atrial rhythm. There was not any evidence of sinus rhythm in the patient clinical history. Conclusions: The present study underlines the rarity of this type of dysrhythmia in childhood and the difficulties in diagnosis and management, above all in a patient who has never showed sinus rhythm. Raising awareness of all available treatment options is essential for a better management of dysrhythmia in children [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
44. Successful treatment of frequent premature ventricular contractions and non-sustained ventricular tachycardia with verapamil and flecainide in RYR1-related myopathy: a case report.
- Author
-
Maruo, Yuji, Saito, Yoshihiko, Nishino, Ichizo, and Takeda, Atsuhito
- Abstract
Background Ryanodine receptor 1 (RYR1)-related myopathies are a group of congenital muscle diseases caused by RYR1 mutations. These mutations may cause centronuclear myopathy, a congenital neuromuscular disorder characterized by clinical muscle weakness and pathological presence of centrally placed nuclei on muscle biopsy. Mutations in RYR2 cause ventricular arrhythmias that can be treated with flecainide; however, reports of ventricular arrhythmias in RYR1 -related myopathies are rare. Herein we report a case of centronuclear myopathy with RYR1 mutations who exhibited frequent premature ventricular contractions (PVCs) and non-sustained ventricular tachycardia (NSVT), which was successfully treated with verapamil and flecainide. Case summary At 7 months, the patient presented neurological manifestations of hypotonia and delayed motor development. A skeletal muscle biopsy performed at age 4 years led to the diagnosis of centronuclear myopathy. At age 15 years, frequent PVCs and NSVT were identified on the electrocardiogram and 24 h Holter monitoring. Treatment with verapamil was initiated; however, it was not beneficial. Therefore, flecainide was added to the treatment, decreasing the frequency of PVCs and NSVT. Non-sustained ventricular tachycardia disappeared at the age of 21, and PVCs almost disappeared at the age of 22. Genetic testing revealed c.13216delG (p.E4406Rfs*35), c.14874G>C (p.K4958N), and c.9892G>A (p.A3298T) in RYR1 , and the compound heterozygosity of variants was confirmed by analysis of the parents. Discussion This is the first report of ventricular arrhythmia associated with RYR1 -related myopathy that was successfully treated with verapamil and flecainide. The combination of verapamil and flecainide may be a useful treatment option for ventricular arrhythmias in patients with RYR1 -related myopathies. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
45. Idiopathic premature ventricular complexes treatment: Comparison of flecainide, propafenone, and sotalol.
- Author
-
Kojić, Dejan, Radunović, Anja, Bukumirić, Zoran, Rajsic, Sasa, Sušić, Maša, Marić, Marija, Žugić, Vasko, Jurčević, Ružica, and Tomović, Milosav
- Subjects
ARRHYTHMIA ,FLECAINIDE ,PROPAFENONE ,CALCIUM antagonists ,MYOCARDIAL depressants - Abstract
Background: Beta‐blockers (BB) or dihydropyridine calcium channel blockers (CCBs) are still the first choices in the treatment of idiopathic premature ventricular complexes (PVCs), with low‐modest efficacy. Antiarrhythmic drugs (AADs) of Ic class are moderate to highly efficient but the evidence on their benefits is still limited. Aim: To compare effectiveness and safety of flecainide, propafenone, and sotalol in the treatment of symptomatic idiopathic PVCs. Methods: Our single‐center retrospective study analyzed 104 consecutive patients with 130 medication episodes of frequent idiopathic PVCs treated with AADs flecainide, propafenone (Ic class) or sotalol (III class). The primary outcome was complete/near complete reduction of PVCs after medication episode (PVCs burden reduction >99%), and the secondary outcome was significant PVC burden reduction (≥80%). Results: The complete/near complete PVCs burden reduction occurred in 31% and was significant in 43% of treated patients. A reduction of PVC burden for >99% was achieved in 56% of patients on flecainide, in 11% of patients on propafenone (p =.002), and in 21% of patients receiving sotalol (p =.031). There was no difference between propafenone and sotalol (p =.174). A reduction of PVC burden for ≥80% was achieved in 64% of patients on flecainide, in 30% of patients on propafenone (p =.009), and 33% of patients on sotalol (p =.020). There was no difference between propafenone and sotalol (p =.661). Conclusions: The efficacy of AADs class Ic and III in the treatment of idiopathic PVCs was modest. Flecainide was the most effective AAD in the achievement of complete/near complete or significant PVC burden reduction, compared to propafenone and sotalol. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
46. Common Structural Pattern for Flecainide Binding in Atrial-Selective Kv1.5 and Nav1.5 Channels: A Computational Approach
- Author
-
Mazola, Yuliet, Montesinos, José CE Márquez, Ramírez, David, Zúñiga, Leandro, Decher, Niels, Ravens, Ursula, Yarov-Yarovoy, Vladimir, and González, Wendy
- Subjects
Pharmacology and Pharmaceutical Sciences ,Biomedical and Clinical Sciences ,Cardiovascular ,Heart Disease ,atrial fibrillation ,multi-target ,drug promiscuity ,druggable binding site ,flecainide ,Na(v)1 ,5 ,K(v)1 ,binding site comparison ,polypharmacology ,Kv1.5 ,Nav1.5 ,Pharmacology and pharmaceutical sciences - Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Its treatment includes antiarrhythmic drugs (AADs) to modulate the function of cardiac ion channels. However, AADs have been limited by proarrhythmic effects, non-cardiovascular toxicities as well as often modest antiarrhythmic efficacy. Theoretical models showed that a combined blockade of Nav1.5 (and its current, INa) and Kv1.5 (and its current, IKur) ion channels yield a synergistic anti-arrhythmic effect without alterations in ventricles. We focused on Kv1.5 and Nav1.5 to search for structural similarities in their binding site (BS) for flecainide (a common blocker and widely prescribed AAD) as a first step for prospective rational multi-target directed ligand (MTDL) design strategies. We present a computational workflow for a flecainide BS comparison in a flecainide-Kv1.5 docking model and a solved structure of the flecainide-Nav1.5 complex. The workflow includes docking, molecular dynamics, BS characterization and pattern matching. We identified a common structural pattern in flecainide BS for these channels. The latter belongs to the central cavity and consists of a hydrophobic patch and a polar region, involving residues from the S6 helix and P-loop. Since the rational MTDL design for AF is still incipient, our findings could advance multi-target atrial-selective strategies for AF treatment.
- Published
- 2022
47. Pilot Randomized Trial With Flecainide in ARVC Patients
- Author
-
Wojciech Zareba, Professor of Medicine/Cardiology
- Published
- 2022
48. Flecainide for conversion and maintenance of sinus rhythm after mitral valve replacement in rheumatic atrial fibrillationWhat is Already Known?What this Study Adds
- Author
-
Umesh Tripathi, Aditya Kapoor, Surendra Kumar Agarwal, Prabhat Tewari, Shantanu Pande, Bipin Chandra, Ankit Sahu, Roopali Khanna, Sudeep Kumar, Naveen Garg, and Satyendra Tewari
- Subjects
Flecainide ,Mitral valve replacement ,Rheumatic heart disease ,Atrial fibrillation ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Despite successful mitral valve replacement (MVR), many patients remain in AF. Flecainide can be useful in these patients but has not been used because of underlying structural heart disease. Methods: We assessed oral flecainide for conversion and maintenance of SR in 25 patients of chronic rheumatic AF following MVR (age 34.4 yrs, mean AF duration: 3.6 yrs). Non-converters underwent DC cardioversion at 24 h and 4 weeks. Patients received flecainide and bb/diltiazem at discharge. Results: Single oral dose of Flecainide achieved SR in 6/25 (24%) while 19/25 achieved SR after DCC; at 24 h 21/25 (84%) were in SR. With mean flecainide dose (93.10 ± 9.40 mg), successful maintenance of SR at 6 months was seen in 16/23 (69.5%). No significant changes in PR interval, QRS duration or QTc were noted; flecainide was well tolerated. Patients in SR had significantly better functional status, QOL scores and higher LA strain at 6 months (25.25 vs 17.43%, p 21% for predicting SR were 87.5/71.43% and 100/85.71% respectively. Conclusion: Oral flecainide was safe and effective in post MVR rheumatic AF patients; maintenance of SR was achieved in 76% of initial converters and 64% of overall population, with better LA strain values. More studies are needed to validate these results.
- Published
- 2023
- Full Text
- View/download PDF
49. Failure of diltiazem to prevent 1:1 conduction of atrial flutter: a case report
- Author
-
K. D. Tiver, D. K. Martin, J. Quah, A. Lahiri, and A. N. Ganesan
- Subjects
Atrial flutter ,1:1 conduction ,Flecainide ,Diltiazem ,Class 1c ,Case report ,Medicine - Abstract
Abstract Background Atrial flutter with 1:1 conduction to the ventricles is a dangerous cardiac arrhythmia. Contemporary guidelines recommend atrioventricular nodal blocking agents should be co-administered with class 1C anti-arrhythmics, as prophylaxis against 1:1 flutter. No guidance is provided on the type or strength of atrioventricular nodal blockade required, and in practice, these agents are frequently prescribed at low dose, or even omitted, due to their side effect profile. Case presentation A 62 year old Caucasian man with a history of paroxysmal atrial fibrillation treated with flecainide, presented with atrial flutter with 1:1 conduction to the ventricles and was cardioverted. Diltiazem was added to prevent this complication and he again presented with atrial flutter with 1:1 conduction to the ventricles, despite prophylaxis with coadministration of diltiazem. Conclusions This case report demonstrates failure of diltiazem to prevent 1:1 flutter in a patient chronically treated with flecainide for paroxysmal atrial fibrillation.
- Published
- 2023
- Full Text
- View/download PDF
50. Flecainide
- Author
-
Pant, AB
- Published
- 2024
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.