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A case of sinus arrest in atrial fibrillation with pulmonary embolism after flecainide ingestion

A 76-year-old female visited the emergency department with complaining of dizziness and syncope. She had a history of paroxysmal atrial fibrillation (AF) and had been prescribed flecainide 50 mg and apixaban 5 mg 12-hourly in another hospital 1 day before the presentation. Upon admission, her electr...

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Autores principales: Jeong, Hyung Ki, Kim, Sung Soo, Kim, Hyun Kuk, Ki, Young Jae, Park, Keun Ho, Choi, Dong Hyun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society for Clinical Pharmacology and Therapeutics 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9810487/
https://www.ncbi.nlm.nih.gov/pubmed/36632074
http://dx.doi.org/10.12793/tcp.2022.30.e19
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author Jeong, Hyung Ki
Kim, Sung Soo
Kim, Hyun Kuk
Ki, Young Jae
Park, Keun Ho
Choi, Dong Hyun
author_facet Jeong, Hyung Ki
Kim, Sung Soo
Kim, Hyun Kuk
Ki, Young Jae
Park, Keun Ho
Choi, Dong Hyun
author_sort Jeong, Hyung Ki
collection PubMed
description A 76-year-old female visited the emergency department with complaining of dizziness and syncope. She had a history of paroxysmal atrial fibrillation (AF) and had been prescribed flecainide 50 mg and apixaban 5 mg 12-hourly in another hospital 1 day before the presentation. Upon admission, her electrocardiogram showed profound bradycardia and extremely long sinus arrest, which required temporary cardiac pacing. Within 24 hours, her intrinsic rhythm was restored, and the temporary pacemaker was removed. Transthoracic and transesophageal echocardiography revealed no structural heart disease or thrombus in the left atrial appendage. Cardiac computed tomography showed no coronary artery stenosis, but a pulmonary thrombus in the right pulmonary artery. She underwent an electrophysiology study, and four pulmonary vein (PV) isolations were attempted to treat the paroxysmal AF. A bidirectional PV conduction block was acquired in all PVs despite spontaneous dissociation of PV potential in the right PV. Programmed stimulation following ablation resulted in sinus node dysfunction. After the procedure, the patient did not complain of dizziness and syncope for 72 hours of telemetry monitoring. She was discharged with anticoagulant and did not show any further symptoms for 6 months. Flecainide acetate is a class Ic antiarrhythmics, and its clinical efficacy has been confirmed in several clinical trials. However, it can unmask sinus node dysfunction in asymptomatic patients with paroxysmal AF. Clinicians should screen candidates for sinus nodal diseases when prescribing flecainide.
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spelling pubmed-98104872023-01-10 A case of sinus arrest in atrial fibrillation with pulmonary embolism after flecainide ingestion Jeong, Hyung Ki Kim, Sung Soo Kim, Hyun Kuk Ki, Young Jae Park, Keun Ho Choi, Dong Hyun Transl Clin Pharmacol Case Report A 76-year-old female visited the emergency department with complaining of dizziness and syncope. She had a history of paroxysmal atrial fibrillation (AF) and had been prescribed flecainide 50 mg and apixaban 5 mg 12-hourly in another hospital 1 day before the presentation. Upon admission, her electrocardiogram showed profound bradycardia and extremely long sinus arrest, which required temporary cardiac pacing. Within 24 hours, her intrinsic rhythm was restored, and the temporary pacemaker was removed. Transthoracic and transesophageal echocardiography revealed no structural heart disease or thrombus in the left atrial appendage. Cardiac computed tomography showed no coronary artery stenosis, but a pulmonary thrombus in the right pulmonary artery. She underwent an electrophysiology study, and four pulmonary vein (PV) isolations were attempted to treat the paroxysmal AF. A bidirectional PV conduction block was acquired in all PVs despite spontaneous dissociation of PV potential in the right PV. Programmed stimulation following ablation resulted in sinus node dysfunction. After the procedure, the patient did not complain of dizziness and syncope for 72 hours of telemetry monitoring. She was discharged with anticoagulant and did not show any further symptoms for 6 months. Flecainide acetate is a class Ic antiarrhythmics, and its clinical efficacy has been confirmed in several clinical trials. However, it can unmask sinus node dysfunction in asymptomatic patients with paroxysmal AF. Clinicians should screen candidates for sinus nodal diseases when prescribing flecainide. Korean Society for Clinical Pharmacology and Therapeutics 2022-12 2022-12-15 /pmc/articles/PMC9810487/ /pubmed/36632074 http://dx.doi.org/10.12793/tcp.2022.30.e19 Text en Copyright © 2022 Translational and Clinical Pharmacology https://creativecommons.org/licenses/by-nc/4.0/It is identical to the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/).
spellingShingle Case Report
Jeong, Hyung Ki
Kim, Sung Soo
Kim, Hyun Kuk
Ki, Young Jae
Park, Keun Ho
Choi, Dong Hyun
A case of sinus arrest in atrial fibrillation with pulmonary embolism after flecainide ingestion
title A case of sinus arrest in atrial fibrillation with pulmonary embolism after flecainide ingestion
title_full A case of sinus arrest in atrial fibrillation with pulmonary embolism after flecainide ingestion
title_fullStr A case of sinus arrest in atrial fibrillation with pulmonary embolism after flecainide ingestion
title_full_unstemmed A case of sinus arrest in atrial fibrillation with pulmonary embolism after flecainide ingestion
title_short A case of sinus arrest in atrial fibrillation with pulmonary embolism after flecainide ingestion
title_sort case of sinus arrest in atrial fibrillation with pulmonary embolism after flecainide ingestion
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9810487/
https://www.ncbi.nlm.nih.gov/pubmed/36632074
http://dx.doi.org/10.12793/tcp.2022.30.e19
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