Three Cases of Cardiac Arrest with Massive Flecainide Intoxication Treated with Extracorporeal Assistance

Abstract

Flecainide acetate is a Vaughan Williams class 1C anti-arrhythmic agent. Overdose causes severe cardiac and neurologic disturbances and carries a risk of fatality. No antidote is currently available.We present three cases of massive flecainide intoxication in which the patients were kept alive by extracorporeal circulation. Extracorporeal support in cases of flecainide intoxication is the only approach that can alleviate acute cardiac dysfunction, preserve blood flow to vital organs, and maintain liver metabolism and renal excretion of the toxin, while waiting for the improvement of cardiac function. Furthermore, clinical practice highlights that age, duration of CPR, PH, and lactate levels should not be a hindrance to decision-making, and demonstrates the positive, long-term neurologic and cardiologic outcomes that can be achieved with the use of extracorporeal assistance in the setting of severe flecainide intoxication.