AV nodal reciprocating tachycardia; Wolff-Parkinson-White syndrome & similar conditions w/ accessory pathways. Paroxysmal atrial fibrillation in patients w/ disabling symptoms. Symptomatic sustained ventricular tachycardia. Premature ventricular contractions &/or non-sustained ventricular tachycardia which are causing disabling symptoms, where these are resistant to other therapy or when other treatment has not been tolerated.
Cardiac failure, patient w/ history of MI who has either asymptomatic ventricular ectopics or nonsustained ventricular tachycardia. Long-standing atrial fibrillation w/ no attempt to convert to sinus rhythm, haemodynamically significant valvular heart disease. Sinus nodal dysfunction, atrial conduction defects, 2nd degree or greater AV block, bundle branch block or distal block unless pacing rescue available.
Special Precautions
Correct electrolyte disturbances before instituting therapy. Significant hepatic impairment, patient w/ permanent pacemakers or temporary pacing electrodes; predisposition to cardiac failure. Patient w/ acute onset of atrial fibrillation following cardiac surgery. Plasma monitoring in patient w/ significant renal impairment. Pregnancy. Childn <12 yr. Elderly.
Adverse Reactions
Most commonly, giddiness, dizziness, lightheadedness, visual disturbances, nausea & vomiting. Proarrhythmia may occur in patients w/ structural heart disease &/or significant left ventricular impairment.
Avoid use w/ other Na channel blockers. May cause rise in plasma digoxin. Possible additive negative inotropic effects of β-blockers & other cardiac depressants. Enzyme inducers enhance elimination. Reduce flecainide dosage by 50% when given in the presence of amiodarone.
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