title: Special comments - Neonatal Intensive Care Drug Manual
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  Neonatal Intensive Care Drug Manual
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  bet | 211/654 | Sana | 03.01.2022 | Hajmi | 1,5 Mb. | | #14803 |
  Special comments
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  Evidence
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  Efficacy and safety:
  A review of published cases and subsequent reports found flecainide appeared to be safe (no deaths with usual oral dosing; < 1% incidence of serious proarrhythmia) and effective (73–100 % control, depending on mechanism) in children with supraventricular tachycardia. [1-4] (LOE IV GOR B) However, concerns regarding safety exist in patients with structural heart disease and cardiomyopathy. The Cardiac Arrhythmia and Suppression Trial (adults with AMI) demonstrated increased mortality in patients who received flecainide.[3-5] A report of young patients (4 days to 26 years) administered flecainide for treatment of SVT (n = 369) or VT (n = 103) found efficacy 71.4%, proarrhythmic response 7.4%, cardiac arrest 2.3% and died during treatment 2.1%. Cardiac arrest and deaths occurred predominantly among patients with underlying heart disease, particularly among patients receiving flecainide for supraventricular tachycardia (8.3%).[3] A report in children (n = 229) with congenital heart disease or cardiomyopathy, incidence of cardiac arrest in patients receiving flecainide was 3.0% with a mortality of 4.3%, with no difference in cardiac arrest or mortality rate when compared to patients who received other antiarrhythmics.[4]
  Guidelines: For SVT, flecainide is effective as a first-line agent in infants, but typically used as a second-line agent because of its arrhythmogenic potential. It has been used in infants with re-entrant supraventricular tachycardia including Wolff- Parkinson-White syndrome, focal atrial tachycardia and permanent junctional reciprocating tachycardia (case reports). Has the potential for proarrhythmia in patients with congenital heart disease. Caution is advised when used in patients with congenital heart disease or conduction system disease. Milk feeds may decrease absorption. Concentration monitoring may assist in guiding therapy. Contraindicated if creatinine clearance <50 mL/min or reduced Left Ventricular Ejection Fraction.[6] (LOE IV GOR B)
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