Flecainide in clinical practice

Flecainide, similar to encainide and propafenone, is IC class antiarrhythmic, inhibiting Nav1.5 sodiumchannels in heart muscle cells and modulates cardiac conduction. Despite its over 40-year presence inclinical practice, strong evidence and well-known safety profile, flecainide distribution in Europe hasnot always been equal. In Poland, the drug has been available in pharmacies only since October thisyear, and previously it had to be imported on request. Flecainide can be used successfully in both theacute and chronic treatment of cardiac arrhythmias. The main indication for flecainide is the treatmentof paroxysmal supraventricular tachycardias, including atrial fibrillation, atrioventricular nodalre-entrant tachycardia, atrioventricular re-entrant tachycardia and ventricular arrhythmias in patientswithout structural heart disease. Beyond that, it may be used in some supraventricular tachycardia inchildren and for sustained fetal tachycardia. Many studies indicate its efficacy comparable to or betterthan previously used drugs such as propafenone and amiodarone, depending on the indication. Thisreview aims to highlight the most important clinical uses of flecainide in the light of the latest scientificevidence and to provide an overview of the practical aspects of treatment, including indications, off-labeluse, contraindications, areas of use, monitoring of treatment and most common complications, takinginto account special populations: children and pregnant women