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Electrophysiologic effects and clinical efficacy of flecainide in children with recurrent paroxysmal supraventricular tachycardia


American Journal of Cardiology 62(4): 229-233
Electrophysiologic effects and clinical efficacy of flecainide in children with recurrent paroxysmal supraventricular tachycardia
The electrophysiologic effects of intravenous flecianide were evaluated in 16 patients aged 9 .+-. 4 years: 15 with recurrent paroxysmal supraventricular tachcardia (SVT) and 1 with overt accessory pathway and history of syncope. Eleven patients had an accessory pathway; it was concealed in 2, overt in 9 and in 10 of these patients an orthodromic atrioventricular reentrant tachycardia was induced. Five patients without accessory pathway had an atrioventricular nodal reentrant tachycardia. After intravenous flecaindie (1.5 mg/kg) the effective refractory period of the atrium and ventricle increased significantly; the anterograde and retrograde effective refractory periods of the atrioventricular node did not. Flecainide blocked retrograde conduction in the accessory pathway in 4 patients (effective refractory period 245 .+-. 41 ms) and antergrade conduction in 8 of 9 patients (effective refractory period 284 .+-. 57 ms). The mean cycle length of orthodromic reciprocating tachcardia and atrioventricular nodal reentrant tachycardia increased significantly. After flecainide tachycardia was noninducible in 6 patiens with orthodromic reciprocating tachycardia and in 1 with atrioventricular nodal reentrant tachycardia. It was inducible but nonsustained (.ltoreq.30 seconds) in 1 patients with orthodromic reciprocating tachycardia and in 3 with atrioventricular nodal reentrant tachycardia. Fifteen patients continued oral flecainide treatment for 19 .+-. 11 months. Tachycardia recurred in 3 of 4 patients whose arrhythmia was still inducible and sustained after intravnous flecainide, and in 1 of 11 patients in whom tachycardia was noninducible (7 patients) or inducible but nonsustained (4 patients). During long-term administration in 11 patients, flecainide plasma levels, 2 to 3 hours after morning dose, ranged from 254 to 584 .mu.g/liter (370 .+-. 130). These data suggest that flecainide is a promising drug for short- and long-term therapy of SVT in children.

Accession: 005349274

PMID: 3135739

DOI: 10.1016/0002-9149(88)90217-2

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