{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:56:45Z","timestamp":1781269005231,"version":"3.54.1"},"reference-count":19,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,5]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>We describe the case of a previously healthy adolescent female who presented with chest discomfort and near-syncope, accompanied by trifascicular block and hypotension. Her clinical condition rapidly progressed to cardiogenic shock with neurological impairment. Despite multiple attempts, transvenous pacing failed to achieve consistent ventricular capture. Flecainide intoxication was subsequently confirmed through toxicological analysis. The patient was managed with invasive ventilation, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), sodium bicarbonate and intravenous lipid emulsion therapy, resulting in full neurological and cardiac recovery following a prolonged intensive care unit stay. Flecainide overdose is rare but associated with high mortality due to profound conduction abnormalities and shock. Early recognition and timely escalation to advanced mechanical circulatory support, including VA-ECMO, are critical for survival.<\/jats:p>\n                  <jats:p>Learning points. Prompt identification and advanced haemodynamic support are lifesaving in severe flecainide intoxication, clinicians should consider VA-ECMO early in refractory cases.<\/jats:p>","DOI":"10.1136\/bcr-2025-270574","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:00:18Z","timestamp":1781265618000},"page":"e270574","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Fulminant flecainide intoxication in an adolescent: cardiogenic shock requiring VA-ECMO support"],"prefix":"10.1136","volume":"19","author":[{"given":"Mila","family":"Kovacevic","sequence":"first","affiliation":[{"name":"Cardilology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia"},{"name":"University of Novi Sad Faculty of Medicine, Novi Sad, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Be\u0161enji","sequence":"additional","affiliation":[{"name":"Cardilology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia"},{"name":"University of Novi Sad Faculty of Medicine, Novi Sad, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milana","family":"Jarakovic","sequence":"additional","affiliation":[{"name":"Cardilology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia"},{"name":"University of Novi Sad Faculty of Medicine, Novi Sad, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"Radonjic","sequence":"additional","affiliation":[{"name":"Cardilology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Stefanovic","sequence":"additional","affiliation":[{"name":"Cardilology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia"},{"name":"University of Novi Sad Faculty of Medicine, Novi Sad, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branislav","family":"Crnomarkovic","sequence":"additional","affiliation":[{"name":"Cardilology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia"},{"name":"University of Novi Sad Faculty of Medicine, Novi Sad, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stevan","family":"Keca","sequence":"additional","affiliation":[{"name":"Cardilology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Dimic","sequence":"additional","affiliation":[{"name":"Cardilology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Snezana","family":"Bjelica","sequence":"additional","affiliation":[{"name":"Cardilology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilija","family":"Srdanovic","sequence":"additional","affiliation":[{"name":"Cardilology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia"},{"name":"University of Novi Sad Faculty of Medicine, Novi Sad, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"2026061205000852000_19.6.e270574.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac262"},{"key":"2026061205000852000_19.6.e270574.2","doi-asserted-by":"crossref","DOI":"10.7812\/TPP\/12-086","article-title":"ECG diagnosis: flecainide toxicity","volume":"16","author":"Levis","year":"2012","journal-title":"Perm J"},{"key":"2026061205000852000_19.6.e270574.3","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000905"},{"key":"2026061205000852000_19.6.e270574.4","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.hrcr.2015.12.013","article-title":"Management of life-threatening flecainide overdose: A case report and review of the literature","volume":"2","author":"Vu","year":"2016","journal-title":"HeartRhythm Case Rep"},{"key":"2026061205000852000_19.6.e270574.5","doi-asserted-by":"crossref","first-page":"225","DOI":"10.4103\/ijn.ijn_387_21","article-title":"A Case of Flecainide-Induced Hyponatremia","volume":"33","author":"Ntemka","year":"2023","journal-title":"Indian J Nephrol"},{"key":"2026061205000852000_19.6.e270574.6","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-243326","article-title":"Flecainide toxicity with high pacemaker capture thresholds and associated takotsubo syndrome","volume":"14","author":"Manley-Casco","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2026061205000852000_19.6.e270574.7","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvm090"},{"key":"2026061205000852000_19.6.e270574.8","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1016\/j.hrthm.2021.04.007","article-title":"Flecainide-induced QRS complex widening correlates with negative inotropy","volume":"18","author":"Rab\u00ealo Evangelista","year":"2021","journal-title":"Heart Rhythm"},{"key":"2026061205000852000_19.6.e270574.9","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.jaccas.2020.02.010","article-title":"The Unpaceable Heart","volume":"2","author":"Nadel","year":"2020","journal-title":"JACC Case Rep"},{"key":"2026061205000852000_19.6.e270574.10","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-232691","article-title":"Flecainide toxicity: a presentation to the emergency department with literature review","volume":"13","author":"Ghataoura","year":"2020","journal-title":"BMJ Case Rep"},{"key":"2026061205000852000_19.6.e270574.11","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1080\/15563650.2024.2337028","article-title":"Common pitfalls in the use of hypertonic sodium bicarbonate for cardiac toxic drug poisonings","volume":"62","author":"Chan","year":"2024","journal-title":"Clin Toxicol (Phila)"},{"key":"2026061205000852000_19.6.e270574.12","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.hrcr.2015.01.003","article-title":"Successful treatment of flecainide overdose with sustained mechanical circulatory support","volume":"1","author":"Mandawat","year":"2015","journal-title":"HeartRhythm Case Rep"},{"key":"2026061205000852000_19.6.e270574.13","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318287f874"},{"key":"2026061205000852000_19.6.e270574.14","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(84)90501-0"},{"key":"2026061205000852000_19.6.e270574.15","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1007\/BF00717997","article-title":"Hemofiltration clearance of flecainide in a patient with acute renal failure","volume":"14","author":"Borgeat","year":"1988","journal-title":"Intensive Care Med"},{"key":"2026061205000852000_19.6.e270574.16","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.ajem.2021.08.004","article-title":"Wide complex tachycardia in dialysis patients is not always hyperkalemia","volume":"52","author":"Hoang","year":"2022","journal-title":"Am J Emerg Med"},{"key":"2026061205000852000_19.6.e270574.17","doi-asserted-by":"publisher","DOI":"10.1007\/BF01704725"},{"key":"2026061205000852000_19.6.e270574.18","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1016\/j.ajem.2015.04.012","article-title":"Life-threatening flecainide overdose treated with intralipid and extracorporeal membrane oxygenation","volume":"33","author":"Brumfield","year":"2015","journal-title":"Am J Emerg Med"},{"key":"2026061205000852000_19.6.e270574.19","article-title":"Early Recognition and Management of Flecainide Toxicity: A","volume":"16","author":"Alraee","year":"2024","journal-title":"Case Report and Literature Review Cureus"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-270574","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:00:20Z","timestamp":1781265620000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-270574"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":19,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,12]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bcr-2025-270574"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-270574","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}