Flecainide toxicity with pill-in-pocket approach from accidental overdose: a case report.

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
European Heart Journal: Case Reports Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI:10.1093/ehjcr/ytae522
Mohamad Anas Oudih, Avraham Ginsburg, Mumin Hakim, Fengwei Zou, Nils Guttenplan
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引用次数: 0

Abstract

Background: The Pill-in-the-Pocket (PiP) approach may be used in highly selected patients to achieve acute pharmacological cardioversion into sinus rhythm. Flecainide toxicity is rarely reported, especially with patients who take flecainide as PiP, and only limited evidence exists in its management. We present a case of accidental flecainide overdose for a patient who is on PiP and the acute management strategy.

Case summary: A 78-year-old female with persistent atrial fibrillation (AF), previously underwent pulmonary vein isolation and maintained on verapamil 240 mg twice daily, presented to the electrophysiology clinic following a recent hospital admission for recurrent AF. Due to infrequent recurrent episodes of symptomatic AF, the patient preferred to avoid both repeat ablation and additional daily medications. After an initial trial on telemetric monitoring, a PiP approach with flecainide 300 mg was adopted. Unfortunately, palpitations and dyspnoea in the context of chronic obstructive pulmonary disease exacerbation led the patient to self-medicate with multiple doses of albuterol and flecainide. Twelve-lead electrocardiogram showed slow AF with a wide QRS complex. The patient received 1 g of calcium gluconate with a 180 mEq bolus of sodium bicarbonate 8.4% and was started on continuous sodium bicarbonate infusion at 150 mL/h. Over a 12 h period, the QRS complex narrowed down, and the rhythm returned to normal sinus rhythm with a QRS interval of 136 ms.

Discussion: The PiP strategy with flecainide is safe and effective. Reinforcement of medication dosing and frequency with patient read back is key to avoid accidental toxicity, which could be life-threatening. Treatment with sodium bicarbonate is quick and highly effective.

因意外用药过量而采用口袋药丸法引起的弗来凯尼中毒:病例报告。
背景:口袋里的药丸(PiP)方法可用于经过严格筛选的患者,以实现窦性心律的急性药物心脏复律。氟卡尼毒性鲜有报道,尤其是在服用氟卡尼作为 PiP 的患者中,而且在其管理方面仅存在有限的证据。病例摘要:一位 78 岁的女性患者患有持续性心房颤动(房颤),曾接受过肺静脉隔离术,并一直服用维拉帕米 240 毫克,每天两次。由于无症状房颤的反复发作并不频繁,患者希望避免重复消融和额外的日常用药。在对遥测监测进行初步试验后,采用了使用 300 毫克非卡尼的 PiP 方法。不幸的是,由于慢性阻塞性肺病加重导致心悸和呼吸困难,患者不得不自行服用多剂量的阿布特罗和氟塞尼。十二导联心电图显示患者为缓慢房颤,QRS 波群较宽。患者接受了 1 克葡萄糖酸钙和 180 mEq 8.4% 碳酸氢钠栓剂,并开始以 150 mL/h 的速度持续输注碳酸氢钠。在 12 小时内,QRS 波群缩小,心律恢复正常窦性心律,QRS 间期为 136 毫秒:讨论:使用非卡尼的 PiP 策略安全有效。通过患者回读来强化用药剂量和频率是避免意外中毒的关键,意外中毒可能会危及生命。使用碳酸氢钠治疗既快速又高效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Heart Journal: Case Reports
European Heart Journal: Case Reports Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.30
自引率
10.00%
发文量
451
审稿时长
14 weeks
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