flecainide / Generic mfg. - LARVOL DELTA

Risk of serious bleeding with concomitant use of apixaban or rivaroxaban with amiodarone compared to flecainide or sotalol in patients with atrial fibrillation (ASH 2025) - "Covariates were well balanced post-matching (standardized differences <0.1).After matching, 253 patients in the amiodarone group experienced serious bleeding (25.8 events per1,000 person-years) compared to 175 in the comparator group (16.4 events per 1,000 person-years) (HR,1.53; 95% CI, 1.26 to 1.86).CONCLUSIONIn this comparative safety study, among patients with AF treated with apixaban or rivaroxaban,concomitant use of amiodarone was associated with a higher risk of serious bleeding compared to use offlecainide or sotalol. These findings highlight the importance of considering drug-drug interactions whenmanaging anticoagulated patients with AF to promote safe prescribing and minimize the risk of seriousbleeding complications."

Clinical • Asthma • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Hepatology • Immunology • Nephrology • CYP3A4 • PER1

DRIVE-AF: Dronedarone Rhythm Intervention for Early Atrial Fibrillation (clinicaltrials.gov) - P4 | N=1898 | Not yet recruiting | Sponsor: Inha University Hospital

HEOR • New P4 trial • Atrial Fibrillation • Cardiovascular

Orbital pain beyond the acute phase: A long-term manifestation of carotid dissection (EHF-EHC 2025) - "She was managed with clopidogrel, atorvastatin and antihypertensive therapy.Cardiology follow-up revealed frequent symptomatic ventricular extrasystoles, treated with bisoprolol and flecainide...Low-dose amitriptyline was initiated, with partial symptomatic relief...Multidisciplinary assessment was essential to exclude recurrence or structural complications. This case highlights the need for long-term follow-up and individualised pain management beyond radiological resolution."

Cardiovascular • Hypertension • Musculoskeletal Pain • Pain • Rheumatology

Magnesium in Aconitine-Induced Electrical Storm-Mechanism Yes, Mandate No. (PubMed, Ann Noninvasive Electrocardiol) - "We propose a practical, evidence-based algorithm emphasizing: (1) first-line flecainide 2 mg/kg IV, (2) magnesium sulfate adjunct targeting serum levels of 1.5-2.0 mmol/L, (3) aggressive calcium repletion to > 1.00 mmol/L, (4) early high-flux hemoperfusion within 6 h, and (5) VA-ECMO for refractory cases. Verapamil, diltiazem, and β-blockers as sole agents should be explicitly avoided."

Journal • Review • Cardiovascular • Hypotension

Signature ECG: Exercise induced syncope. (PubMed, Indian Pacing Electrophysiol J) - "The genetic testing showed pathogenic heterozygous variant in CASQ2 gene. Patient was started on propranolol and flecainide and advised to avoid strenuous physical activity."

Journal • Cardiovascular • Ventricular Tachycardia

A Case of Atrial Fibrillation and Rapid Ventricular Response in a 22-Year-Old Athlete With Sickle Cell Trait. (PubMed, Cureus) - "The patient was administered intravenous (IV) diltiazem for rate control, and synchronized cardioversion was successfully performed to restore sinus rhythm. Short-term anticoagulation therapy with apixaban was prescribed, along with flecainide on an as-needed basis for rhythm management...Preventive measures for athletes with SCT should include adequate hydration, heat acclimatization, and education of players and coaching staff. This case highlights the importance of heightened awareness, adherence to guideline-based management, and the necessity for further research into the association between SCT and AF in young athletes."

Journal • Atrial Fibrillation • Cardiovascular • Genetic Disorders • Hematological Disorders • Metabolic Disorders • Sickle Cell Disease • Ventricular Tachycardia

Blocked Atrial Bigeminy as an Unusual Cause of Bradycardia: A Case Report. (PubMed, Int Med Case Rep J) - "Therapy with flecainide and amiodarone separately was not effective...The target values of blood pressure were achieved with candesartan at a dose of 32 mg...Recognition of the P wave superimposed on the ST segment or the T wave may be a clue for a correct diagnosis. Physicians should be aware of this condition to avoid unnecessary pacemaker implantation."

Journal • Cardiovascular • Hypertension • Pulmonary Arterial Hypertension

Quadruple parametric optical mapping to measure cardiac metabolism-excitation-contraction coupling. (PubMed, Commun Biol) - "Using this technique, we demonstrate known and novel cardiac responses to nifedipine and flecainide. We determine chronological changes in MECC with FCCP and ischemia/reperfusion to understand the interplay between electrical, mechanical, and metabolic functions in the heart and mechanisms underlying arrhythmogenesis."

Journal • Cardiovascular • Reperfusion Injury

Shortening Duration of Antiarrhythmic Medication for SVT in Infants (clinicaltrials.gov) - P=N/A | N=107 | Completed | Sponsor: Tampere University Hospital | Recruiting ➔ Completed | N=70 ➔ 107

Enrollment change • Trial completion • Cardiovascular • Ventricular Tachycardia

Serum Alkalinization Affects Elimination of Flecainide in Chronic Toxicity: A Case Report. (PubMed, Case Rep Crit Care) - "Tissue redistribution as a result of serum alkalinization likely contributed to impaired elimination in a patient with chronic flecainide toxicity. Serum alkalinization from sodium bicarbonate administration has implications in the length of stay and need for adjunctive therapies in the treatment of flecainide toxicity."

Journal • Cardiovascular • Metabolic Disorders

Under Recognized Toxicity of Flecainide Overdose. (PubMed, Prehosp Emerg Care) - "The patient was also given sodium bicarbonate, lorazepam, levetiracetam, lidocaine, amiodarone, and lipid emulsion. In general, one cannot know whether a longer transfer time will result in critical decompensation. Nonetheless, one might consider certain presentations with capacity for critical illness requiring highly specialized care as an indication for direct transport."

Journal • Cardiovascular • CNS Disorders • Critical care • Epilepsy • Hypotension • Pediatrics • Ventricular Tachycardia

MC.AOS.01: Metabolic Stress, Mitochondrial Injury, and Inflammatory Drivers in Cardiac Pathophysiology (AHA 2025) - "In rapid-fire style, the talks explore retinol-binding protein 4–mediated oxidative stress in MAFLD-related ischemia, suppressed mitochondrial fuel metabolism in HFpEF, and Klotho-regulated mitochondrial damage in heart failure. Additional presentations examine macrophage-driven mitochondrial dysfunction in fulminant myocarditis, FSCN1 as an epigenetic-mitochondrial therapeutic target, and the surprising induction of neuronal sodium channels by long-term flecainide exposure, revealing new insights into arrhythmic risk."

Cardiovascular • Congestive Heart Failure • Heart Failure • Inflammation • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • Fascin • FSCN1 • RBP4

Efficacy and Safety of Flecainide Versus Amiodarone for the Cardioversion of paroxysmal Atrial Fibrillation in Patients with Coronary Artery Disease without residual ischemia: The FLECA-ED Randomized Clinical Trial (AHA 2025) - P3 | "Flecainide was as safe and superior to amiodarone for AF cardioversion in CAD patients without residual ischemia. These findings challenge traditional contraindications and support the re-evaluation of flecainide use in this specific population."

Clinical • Acute Coronary Syndrome • Atrial Fibrillation • Cardiovascular • Coronary Artery Disease • Hypotension

Deglutition-Induced Atrial Fibrillation in a Previously Healthy Adult Male: A Rare Trigger Unmasked After Medication Discontinuation. (PubMed, Cureus) - "Initially diagnosed with paroxysmal AF and successfully managed on flecainide and bisoprolol, the patient became asymptomatic, and his Holter monitor prior to the latest admission showed he maintained sinus rhythm. Investigations ruled out structural heart disease, thyroid dysfunction, and electrolyte abnormalities. This case highlights the importance of recognizing atypical triggers of AF."

Journal • Atrial Fibrillation • Cardiovascular • Endocrine Disorders • Heart Failure

Pharmaceuticals and transformation products in coastal waters of the Iberian Peninsula. (PubMed, Mar Environ Res) - "This study shows that pharmaceutical pollution is widespread in coastal waters across the west and southern parts of the Iberian Peninsula. Furthermore, we report the first detection of flecainide and 7 metabolites-TPs in coastal-marine environments."

Journal

Frequency and Outcomes of Intentional Non-Therapy for Infants Identified with Genotype-Positive Long QT Syndrome Following Cascade Testing (AHA 2025) - "Management was escalated from integer to prophylactic pharmacologic therapy in 8 infants (21%) with nadolol in 4, propranolol in 3, and LQT3 mutation-specific therapy with flecainide in 1 based on 2 consecutive QTc values>470ms, at a mean age of 4.3±2 years (mean QTc at treatment initiation 485±13ms).ConclusionsIn selected LQTS infants with favorable down-trending QT and access to close follow-up, integer rather than universal prophylactic drug therapy can be considered. This approach may offer an alternative strategy in infancy, avoiding unnecessary early exposure to medication-related side effects and reinforcing individualized genotype- and phenotype-directed tailoring of therapeutic options."

Cardiovascular

Cardiogenic Shock due to Flecainide Toxicity: No substitute for time. (AHA 2025) - "Treatment of flecainide toxicity included sodium bicarbonate boluses, anti-tachycardia pacing, synchronized cardioversion, and amiodarone infusion...Cardiogenic shock was managed with bumetanide infusion and placement of an intra-aortic balloon pump...The patient did not tolerate milrinone due to hypotension and tachycardia...None of the antiarrhythmic strategies were immediately successful at restoring sinus rhythm. Ultimately, the most successful strategy was tincture of time to allow for flecainide clearance and the patient recovered."

Acute Kidney Injury • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Heart Failure • Hypotension • Nephrology • Pulmonary Disease • Renal Disease

Flecainide Reduces Exercise-Induced Arrhythmic Burden in PKP2-Related Arrhythmogenic Cardiomyopathy (AHA 2025) - "Eight patients (mean age 31 ± 13 years, 50% male) underwent both on and off flecainide for a total of 29 ESTs [on beta-blockers (80%), flecainide (52%), amiodarone (3%), or sotalol (3%)]. Flecainide significantly reduces the EST arrhythmic burden in patients with PKP2-ACM, particularly in the recovery phase. Future studies are needed to determine if the EST can be used to guide flecainide dosing and efficacy in PKP2-ACM akin to current strategies employed for catecholaminergic polymorphic ventricular tachycardia."

Cardiomyopathy • Cardiovascular • Ventricular Tachycardia

Long-term Flecainide Exposure Triggers Expression of Neuronal Sodium Channels in the Murine Heart (AHA 2025) - "Flecainide effectively treats arrhythmias but increases arrhythmic deaths in patients with structural heart disease/ischemia. We show that flecainide treatment increases the contributions of neuronal sodium channel isoforms to INa. These isoforms have distinct biophysical properties which may promote arrhythmogenesis, potentially explaining the adverse outcomes in the CAST trial and offering potential therapeutic strategies."

Preclinical • Cardiovascular • Congestive Heart Failure • Heart Failure • Myocardial Infarction • NAV1

A Rare Case of Genetic Cardiomyopathy: SCN5A mutation-associated Multifocal Ectopic Premature Purkinje-related Complexes Syndrome with Heart Failure with Improved Ejection Fraction (AHA 2025) - "He had recurrent VT and PVCs despite being on amiodarone. LV dysfunction requires optimal GDMT. In this case, complete LV function recovery was achieved with excellent rhythm control on flecainide along with maximally tolerated GDMT."

Clinical • Atrial Fibrillation • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Fatigue • Fibrosis • Heart Failure • Hypertension • Immunology

A Rare Case of Idiopathic Ventricular Fibrillation Triggered by Short-Coupled PVCs from the Apical Free Wall of the Right Ventricle (AHA 2025) - "Due to inadequate response and proarrhythmic concerns, flecainide was discontinued and verapamil initiated, resulting in immediate suppression of arrhythmias. This case illustrates a rare but potentially fatal presentation of IVF triggered by short-coupled PVCs from the apical free wall of the right ventricle. The ECG morphology, short coupling interval, and verapamil responsiveness support a DAD-mediated mechanism. Recognition of this unusual origin is crucial, as targeted ablation can be curative."

Clinical • Cardiovascular • Heart Failure

Tachycardia-induced Cardiomyopathy from Incessant Atrial Tachycardia in a Teenager with Severe Pectus Excavatum (AHA 2025) - "Initial medical therapy with ivabradine, flecainide, and atenolol led to rate control and subsequent improvement in left ventricular function but failed to terminate the arrhythmia...Postoperatively, left ventricular function normalized, but AT persisted despite continued escalation to ivabradine, sotalol, and flecainide...The p wave morphology on electrocardiogram, left atrial deformity on echocardiogram, and intracardiac activation map of the AT focus in this case, support cardiac compression as the mechanism for AT. These findings suggest the potential for sustained atrial remodeling with subsequent arrhythmia in the context of PE and underscores the importance of cardiac screening in asymptomatic adolescents with severe chest wall deformities."

Cardiomyopathy • Cardiovascular • Pediatrics

THE SUCCESSFUL MANAGEMENT OF A FLECANIDE-INDUCED VENTRICULAR STORM (CHEST 2025) - "CASE PRESENTATION: 68-year-old female with past medical history of COPD, dyslipidemia, GIST, paroxysmal atrial fibrillation on Xarelto and flecainide, GERD who presented for lightheadedness, fatigue, nausea, and vomiting following radiation and sunitinib treatment for her GIST tumor. Flecainide has a side effect of being a proarrhythmic drug despite its current treatment of atrial fibrillation. One of the aberrant rhythms that flecainide can cause is ventricular tachycardia. Once ventricular tachycardia occurs various cases have demonstrated lidocaine as an affective measure to abort this tachycardia."

Atrial Fibrillation • Cardiovascular • Chronic Obstructive Pulmonary Disease • Dyslipidemia • Fatigue • Gastroesophageal Reflux Disease • Heart Failure • Immunology • Metabolic Disorders • Respiratory Diseases • Ventricular Tachycardia

Metabolomics-guided discovery of bioactive compounds from Cunninghamella echinulata isolate SMH-1 for dual-target control of Solenopsis invicta. (PubMed, Pestic Biochem Physiol) - "The bioactivity of isolate SMH-1 (conidia), (extracts) and (Dihydrocoumarin) against S. invicta revealed significantly differentiated metabolites as (Sulfolithocholylglycine, PE(18_1(9Z)_0_0), CE(12:0), LysoPI(18:1(9Z)/0:0) and Hydroxydestruxin B), (Tropine, lignoceric acid, 9-deoxy-9-methylene-16,16-dimethyl -PGE2, Flecainide and Jubanine B), and (3-O-alpha-D-Glucopyranuronosyl-D-xylose, Rilmakalim, 2-Amino-3-methyl-1-butanol, 2,4-Dimethyl-1,3-oxazole-5-carboxylic acid and Caffeinol), respectively...These findings underscore SMH-1's multifaceted bio control potential, combining direct pathogenicity, thermo-tolerance, and metabolite-mediated toxicity. By delineating host-pathogen interactions and metabolic disruptions, this work advances C. echinulata isolate SMH-1 as a sustainable candidate for integrated S. invicta management, offering an eco-friendly alternative to synthetic insecticides."

Journal • Infectious Disease • Metabolic Disorders

Reappraising Use of Flecainide for Atrial Fibrillation and Ventricular Arrhythmias in Structural Heart Disease Patients. (PubMed, Medicina (Kaunas)) - " Flecainide use in selected SHD patients appears both feasible and safe when guided by comprehensive imaging and clinical judgment. The need for prospective randomized trials to confirm these findings and potentially inform future guideline updates is urgent and of utmost importance in the field of antiarrhythmic therapies."

Journal • Review • Atrial Fibrillation • Cardiomyopathy • Cardiovascular • Coronary Artery Disease • Heart Failure