{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T18:30:40Z","timestamp":1787596240823,"version":"build-2736575974"},"reference-count":19,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hum Lact"],"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Flecainide is a class 1c antiarrhythmic drug used to manage ventricular and supraventricular arrhythmias. Its use in women of childbearing age is limited due to concerns about adverse outcomes. However, existing data suggest that flecainide may be safely used during pregnancy for maternal and neonatal arrhythmias. Its pharmacokinetic properties allow placental and breastmilk passage, but data on neonatal exposure via lactation remain scarce. This case report investigates the safety of maternal flecainide use during breastfeeding by analysing clinical and biochemical data in one nursed infant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A 33-year-old primigravida with a history of right ventricular outflow tract tachycardia was maintained on flecainide 200\u2009mg\/day throughout pregnancy and lactation. The infant, delivered at term with no complications, was exclusively breastfed initially and later received a reduced volume.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The infant underwent clinical and biochemical evaluations and ECG monitoring at 5, 7, and 30\u2009days postpartum. All assessments, including heart rate, rhythm, and QT intervals, remained within normal ranges. Maternal plasma flecainide levels were within the therapeutic range. Despite significant flecainide concentrations in breastmilk, neonatal plasma levels remained below the lower limit of detection, and no adverse effects were observed.<\/jats:p>\n                    <jats:p>Relative infant dose calculations remained under the recommended 10% threshold.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion &amp; Discussion:<\/jats:title>\n                    <jats:p>This case report supports the safe use of flecainide during lactation. Despite detectable flecainide in breastmilk, infant exposure remained subclinical. These findings align with prior case studies. Clinicians may safely recommend breastfeeding in the case of maternal flecainide use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08903344261452630","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:41:10Z","timestamp":1787316070000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Maternal Flecainide Use in the Nursed Infant\u2014A Case Report"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7975-3118","authenticated-orcid":false,"given":"Lisa","family":"Willems","sequence":"first","affiliation":[{"name":"Department of Paediatrics, VieCuri Medical Center, Venlo, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5382-6147","authenticated-orcid":false,"given":"Hylke","family":"van der Heijden","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, VieCuri Medical Center, Venlo, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frits","family":"van Osch","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands"},{"name":"Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary-Anne","family":"Funnekotter-van der Snoek","sequence":"additional","affiliation":[{"name":"Department of Hospital Pharmacy, VieCuri Medical Center, Venlo, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"e_1_3_3_2_1","unstructured":"Bijwerkingen Centrum Lareb. (2019 March 19). Hartritmestoornissen tijdens de borstvoedingsperiode. Retrieved March 23 2023 from https:\/\/www.lareb.nl\/mvm-kennis-pagina?id=354&pagina=1&zoekterm=C01BC04&isSinglePageResult=true&zwangerschap=false&borstvoeding=true&naam=Hartritmestoornissen%20tijdens%20de%20borstvoedingsperiode"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"Bourget P. Pons J. C. Delouis C. Fermont L. Frydman R. (1994). Flecainide distribution transplacental passage and accumulation in the amniotic fluid during the third trimester of pregnancy. The Annals of pharmacotherapy 28(9) 1031\u20131034. https:\/\/doi.org\/10.1177\/106002809402800907","DOI":"10.1177\/106002809402800907"},{"key":"e_1_3_3_4_1","doi-asserted-by":"crossref","unstructured":"Bratincs\u00e1k A. Kimata C. Limm-Chan B. N. Vincent K. P. Williams M. R. Perry J. C. (2020). Electrocardiogram standards for children and young adults using Z-scores. 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Flecainide is a safe and effective treatment for pre-excited atrial fibrillation rapidly conducted to the ventricle in pregnant women: A case series. European Heart Journal - Case Reports 3(2) ytz066. https:\/\/doi.org\/10.1093\/ehjcr\/ytz066","DOI":"10.1093\/ehjcr\/ytz066"},{"key":"e_1_3_3_7_1","doi-asserted-by":"crossref","unstructured":"Echt D. S. Liebson P. R. Mitchell L. B. Peters R. W. Obias-Manno D. Barker A. H. Arensberg D. Baker A. Friedman L. Greene H. L. (1991). Mortality and morbidity in patients receiving encainide flecainide or placebo\u2009\u2014\u2009The cardiac arrhythmia suppression trial. The New England journal of medicine 324(12) 781\u2013788. https:\/\/doi.org\/10.1056\/nejm199103213241201","DOI":"10.1056\/NEJM199103213241201"},{"key":"e_1_3_3_8_1","volume-title":"Drug monograph flecainide","author":"Gold Standard Drug Database","year":"2018","unstructured":"Gold Standard Drug Database. (2018, March 1). Drug monograph flecainide. Elsevier."},{"key":"e_1_3_3_9_1","doi-asserted-by":"crossref","unstructured":"Marchlinski F. E. Deely M. P. Zado E. S. (2000). Sex-specific triggers for right ventricular outflow tract tachycardia. American Heart Journal 139(6) 1009\u20131013. https:\/\/doi.org\/10.1067\/mhj.2000.106164","DOI":"10.1067\/mhj.2000.106164"},{"key":"e_1_3_3_10_1","doi-asserted-by":"crossref","unstructured":"McQuinn R. L. Pisani A. Wafa S. Chang S. F. Miller A. M. Frappell J. M. Chamberlain G. V. Camm A. J. (1990). Flecainide excretion in human breast milk. Clinical Pharmacology and Therapeutics 48(3) 262\u2013267. https:\/\/doi.org\/10.1038\/clpt.1990.148","DOI":"10.1038\/clpt.1990.148"},{"key":"e_1_3_3_11_1","doi-asserted-by":"crossref","unstructured":"Meek J. Y. Noble L. & Section on Breastfeeding. (2022). Policy statement: Breastfeeding and the use of human milk. Pediatrics 150(1) e2022057988. https:\/\/doi.org\/10.1542\/peds.2022-057988","DOI":"10.1542\/peds.2022-057988"},{"key":"e_1_3_3_12_1","unstructured":"M\u00e9decins Sans Fronti\u00e8res. (n.d.). Appendix 4. Daily amounts required for feeding. MSF Medical Guidelines."},{"key":"e_1_3_3_13_1","doi-asserted-by":"crossref","unstructured":"Palmer C. M. Norris M. C. (1990). Placental transfer of flecainide. American Journal of Diseases of Children (1960) 144(2) 144. https:\/\/doi.org\/10.1001\/archpedi.1990.02150260022014","DOI":"10.1001\/archpedi.1990.02150260022014"},{"key":"e_1_3_3_14_1","doi-asserted-by":"crossref","unstructured":"Pizzoglio V. Auffret M. Vial T. Gouraud A. (2023). Follow-up of breastfed infants exposed to maternal flecainide treatment. Neurotoxicology and Teratology 98 107247. https:\/\/doi.org\/10.1016\/j.ntt.2023.107247","DOI":"10.1016\/j.ntt.2023.107247"},{"key":"e_1_3_3_15_1","doi-asserted-by":"crossref","unstructured":"Regitz-Zagrosek V. Roos-Hesselink J. W. Bauersachs J. Blomstr\u00f6m-Lundqvist C. C\u00edfkov\u00e1 R. De Bonis M. Iung B. Johnson M. R. Kintscher U. Kranke P. Lang I. M. Morais J. Pieper P. G. Presbitero P. Price S. Rosano G. M. C. Seeland U. Simoncini T. Swan L. \u2026 ESC Scientific Document Group. (2018). 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. European Heart Journal 39(34) 3165\u20133241. https:\/\/doi.org\/10.1093\/eurheartj\/ehy340","DOI":"10.1093\/eurheartj\/ehy340"},{"key":"e_1_3_3_16_1","doi-asserted-by":"crossref","unstructured":"Tamirisa K. P. Elkayam U. Briller J. E. Mason P. K. Pillarisetti J. Merchant F. M. Patel H. Lakkireddy D. R. Russo A. M. Volgman A. S. Vaseghi M. (2022). Arrhythmias in Pregnancy. JACC: Clinical Electrophysiology 8(1) 120\u2013135. https:\/\/doi.org\/10.1016\/j.jacep.2021.10.004","DOI":"10.1016\/j.jacep.2021.10.004"},{"key":"e_1_3_3_17_1","doi-asserted-by":"crossref","unstructured":"van der Zande J. A. Cornette J. M. J. Roos-Hesselink J. W. 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