Is there any routine monitoring we need to do for outpatients on flecainide?
Probably only an EKG. As you know, we have to ensure there is no structural heart disease and no significant coronary disease before initiating flecainide. After starting the drug, we may see widening of the QRS/prolongation of the QT interval, up to 25%. The European guidelines say to stop flecainide if the QRS widens more than 25%; the AHA/ACC guidelines say that more than 25% widening may indicate higher likelihood of arrhythmias. I am not finding anything that suggests obtaining routine labs, although the dose does need to be adjusted for liver or bad kidney dysfunction.
Central Illustration. An important considerations for clinical practice use of flecainide
I'm attaching a pretty good review article on flecainide. (I think I've shared with you before that anti-arrhythmics are still a work in progress for me.) I'm also attaching some helpful tip sheets from ACC on flecainide, sotalol, and amiodarone, and I'll post these in the clinic this week.
Amiodarone (Cordarone, Pacerone) Considerations for Use* US/FDA Approved Indications: Heart Rate Control and Heart Rhythm Control for Atrial Fibrillation. https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Tools%20and%20Practice%20Support/Quality%20and%20Clinical%20Toolkits/AFib%20Toolkit/Amiodarone.pdf?la=en
Basza M, Maciejewski C, Bojanowicz W, et al. Flecainide in clinical practice. Cardiology Journal. Published online March 10, 2023. doi:https://doi.org/10.5603/cj.a2023.0018
Flecainide (Tambocor) Considerations for Use* US/FDA Approved Indications: Heart Rhythm Control for Atrial Fibrillation. Accessed September 9, 2024. https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Tools%20and%20Practice%20Support/Quality%20and%20Clinical%20Toolkits/AFib%20Toolkit/Flecainide.pdf?la=en
Sotalol (Betapace, Sorine) Considerations for Use* US/FDA Approved Indications: Heart Rhythm Control for Atrial Fibrillation. American College of Cardiology. https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Tools%20and%20Practice%20Support/Quality%20and%20Clinical%20Toolkits/AFib%20Toolkit/Sotalol.pdf?la=en
