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World J Cardiol. Feb 26, 2015; 7(2): 76-85
Published online Feb 26, 2015. doi: 10.4330/wjc.v7.i2.76
Flecainide: Current status and perspectives in arrhythmia management
George K Andrikopoulos, Sokratis Pastromas, Stylianos Tzeis
George K Andrikopoulos, Sokratis Pastromas, Stylianos Tzeis, Department of Cardiology, Henry Dunant Hospital, Athens, 11526 Attica, Greece
Author contributions: All authors contributed equally to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: George K Andrikopoulos, MD, PhD, Director of Cardiology Department, Henry Dunant Hospital, Mesogeion ave 107, Athens, 11526 Attica, Greece. andrikop@hotmail.com
Telephone: +30-210-6972876 Fax: +30-210-6972200
Received: July 27, 2014
Peer-review started: July 28, 2014
First decision: August 14, 2014
Revised: August 31, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: February 26, 2015
Processing time: 199 Days and 2.5 Hours
Abstract

Flecainide acetate is a class IC antiarrhythmic agent and its clinical efficacy has been confirmed by the results of several clinical trials. Nowadays, flecainide is recommended as one of the first line therapies for pharmacological conversion as well as maintenance of sinus rhythm in patients with atrial fibrillation and/or supraventricular tachycardias. Based on the Cardiac Arrhythmia Suppression Trial study results, flecainide is not recommended in patients with structural heart disease due to high proarrhythmic risk. Recent data support the role of flecainide in preventing ventricular tachyarrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia associated both with ryanodine receptor and calsequestrin mutations. We herein review the current clinical data related to flecainide use in clinical practice and some concerns about its role in the management of patients with coronary artery disease.

Keywords: Flecainide; Class IC antiarrhythmic drugs; Atrial fibrillation; Ventricular tachycardia; Proarrhythmia

Core tip: Flecainide acetate is recommended as one of the first line antiarrhythmic drugs in patients with atrial fibrillation and/or supraventricular tachycardias for the restoration and maintance of sinus rhythm. Based on the Cardiac Arrhythmia Suppression Trial study results, flecainide is contraindicated for patients with structural heart disease due to high proarrhythmic risk. Recent data support the role of flecainide in preventing ventricular tachyarrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia associated both with ryanodine receptor and calsequestrin mutations.