Author + information
- Received April 7, 1986
- Revision received July 16, 1986
- Accepted August 13, 1986
- Published online January 1, 1987.
- Angelo A.V. de Paola, MD1,2,
- Leonard N. Horowitz, MD, FACC*,1,
- Joel Morganroth, MD, FACC1,
- Sheila Senior, RN1,
- Scott R. Spielman, MD, FACC1,
- Allan M. Greenspan, MD, FACC1 and
- Harold R. Kay, FACC1
- ↵*Address for reprints: Leonard N. Horowitz MD, Likoff Cardiovascular Institute, Hahnemann University and Hospital, Broad and Vine Streets, Philadelphia, Pennsylvania 19102.
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%.
- Received April 7, 1986.
- Revision received July 16, 1986.
- Accepted August 13, 1986.
- American College of Cardiology