Influence of left ventricular dysfunction on flecainide therapy

Seventy-six patients with ventricular tachyarrhythmias (40 sustained and 36 nonsustained) were treated with oral flecainide. Radionuclide left ventricular ejection fraction was 30% or less in 33 patients and greater than 30% in 43 patients. Before flecainide, compensated heart failure was present in...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 1987-01, Vol.9 (1), p.163-168
Main Authors: de Paola, Angelo A.V., Horowitz, Leonard N., Morganroth, Joel, Senior, Sheila, Spielman, Scott R., Greenspan, Allan M., Kay, Harold R.
Format: Article
Language:English
Subjects:
Adult
Aged
Antiarythmic agents
Biological and medical sciences
Cardiovascular system
Female
Flecainide - therapeutic use
Follow-Up Studies
Heart Failure - physiopathology
Humans
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Stroke Volume
Tachycardia - drug therapy
Tachycardia - physiopathology
Time Factors
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Summary:Seventy-six patients with ventricular tachyarrhythmias (40 sustained and 36 nonsustained) were treated with oral flecainide. Radionuclide left ventricular ejection fraction was 30% or less in 33 patients and greater than 30% in 43 patients. Before flecainide, compensated heart failure was present in 23 patients (ejection fraction ≤ 30% in 15 and > 30% in 8). Flecainide mean dose was 150 mg twice daily and mean plasma concentration was 720 ng/ml. New or worsened congestive heart failure occurred in seven patients on flecainide therapy, all with an ejection fraction of less than 30%; six had a previous history of compensated heart failure and of these, three died. Ejection fraction was the only independent variable that significantly influenced efficacy and tolerance of flecainide. After 1 year of therapy, efficacy and tolerance was 58% (25 of 43) in patients with an ejection fraction greater than 30% and 12% (4 of 33) in patients with an ejection fraction of 30% or less (p < 0.001). Thus, congestive heart failure can occur during flecainide therapy, particularly in patients with a previous history of congestive heart failure and ejection fraction of less than 30%, and may particularly limit therapy in these patients. Clinical efficacy and tolerance were significantly lower in patients with an ejection fraction of less than 30%.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(87)80096-7