{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T23:20:00Z","timestamp":1784244000377,"version":"3.55.0"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Flecainide is a Class IC antiarrhythmic drug used to treat arrhythmias such as atrial fibrillation (AF), paroxysmal supraventricular tachycardia, and ventricular tachycardia (VT). Its mechanism involves blocking sodium channels, leading to QRS widening, especially at higher heart rates. This property increases the risk of pro-arrhythmic events, particularly in patients with structural heart disease or ischaemia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 67-year-old woman receiving flecainide for AF suffered an ischaemic stroke and later developed VT resistant to amiodarone and direct current cardioversion. Her condition improved significantly after intravenous sodium bicarbonate was administered, which counteracted the effects of sodium channel blockade. Later, she was found to have hyponatremia and slightly elevated flecainide values above the upper limit. This case highlights the complexities of flecainide therapy and the importance of timely intervention in managing arrhythmias.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>This case underscores the arrhythmogenic potential of flecainide. The development of VT suggests that flecainide may have created a substrate for arrhythmias due to its effects on cardiac conduction. The successful use of sodium bicarbonate illustrates an effective treatment strategy for reversing flecainide-induced toxicity. Clinicians should remain vigilant and consider alternative therapies in managing patients at risk for arrhythmias while on flecainide.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf368","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T05:39:01Z","timestamp":1753767541000},"source":"Crossref","is-referenced-by-count":5,"title":["Flecainide fallout: a rare case report of refractory ventricular tachycardia and updated management strategies"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6990-4669","authenticated-orcid":false,"given":"Abhishek","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Cardiology, Government Super Speciality Hospital CIMS, Koni , Bilaspur, Chhattisgarh 495009 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3756-8383","authenticated-orcid":false,"given":"Manisha","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Neurology, DKS Postgraduate and Research Institute , Ghadi Chowk, Raipur, Chhattisgarh 492002 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3840-7515","authenticated-orcid":false,"given":"Amratansh","family":"Varshney","sequence":"additional","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences , Tatibandh, Raipur, Chhattisgarh 492009 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3893-9138","authenticated-orcid":false,"given":"Rounak","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences , Tatibandh, Raipur, Chhattisgarh 492009 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"2025081217271090900_ytaf368-B1","doi-asserted-by":"crossref","first-page":"76","DOI":"10.4330\/wjc.v7.i2.76","article-title":"Flecainide: current status and perspectives in arrhythmia management","volume":"7","author":"Andrikopoulos","year":"2015","journal-title":"World J Cardiol"},{"key":"2025081217271090900_ytaf368-B2","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1161\/01.CIR.84.4.1808","article-title":"Proarrhythmic effects of flecainide. Experimental evidence for increased susceptibility to reentrant arrhythmias","volume":"84","author":"Brugada","year":"1991","journal-title":"Circulation"},{"key":"2025081217271090900_ytaf368-B3","doi-asserted-by":"crossref","first-page":"473","DOI":"10.5603\/CJ.a2023.0018","article-title":"Flecainide in clinical practice","volume":"30","author":"Basza","year":"2023","journal-title":"Cardiol J"},{"key":"2025081217271090900_ytaf368-B4","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/j.amjcard.2019.12.041","article-title":"Use of flecainide for the treatment of atrial fibrillation","volume":"125","author":"Echt","year":"2020","journal-title":"Am J Cardiol"},{"key":"2025081217271090900_ytaf368-B5","first-page":"25","article-title":"Management of sodium-channel blocker poisoning: the role of hypertonic sodium salts","volume":"14","author":"Di Grande","year":"2010","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2025081217271090900_ytaf368-B6","first-page":"e22261","article-title":"A case report of flecainide toxicity with review of literature","volume":"14","author":"Khatiwada","year":"2022","journal-title":"Cureus"},{"key":"2025081217271090900_ytaf368-B7","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1136\/emj.2006.044362","article-title":"Flecainide cardiotoxicity precipitated by electrolyte imbalance. Caution with thiazide diuretics","volume":"24","author":"Khavandi","year":"2007","journal-title":"Emerg Med J"},{"key":"2025081217271090900_ytaf368-B8","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s13054-020-02885-8","article-title":"Brain-heart interaction after acute ischemic stroke","volume":"24","author":"Battaglini","year":"2020","journal-title":"Crit Care"},{"key":"2025081217271090900_ytaf368-B9","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.hrcr.2019.05.007","article-title":"A case of electrolyte disturbances leading to flecainide toxicity at normal serum levels and pacemaker malfunction","volume":"5","author":"Kasia","year":"2019","journal-title":"HeartRhythm Case Rep"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytaf368\/63867895\/ytaf368.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/8\/ytaf368\/63867895\/ytaf368.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/8\/ytaf368\/63867895\/ytaf368.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T21:27:20Z","timestamp":1755034040000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytaf368\/8215669"}},"subtitle":[],"editor":[{"given":"Patrick","family":"Badertscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Boldizsar","family":"Kovacs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Peter","family":"H\u00e4mmerle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Andrea","family":"Papa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Nicolo","family":"Sisti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,29]]},"references-count":9,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytaf368","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,7,29]]},"article-number":"ytaf368"}}