FLECAINIDE OVERDOSE - IS CARDIOPULMONARY SUPPORT THE TREATMENT

Flecainide toxicity can impair cardiac function and precipitate circul atory collapse, which in turn depresses clearance and redistribution o f flecainide. Treatment directed at improving cardiac function is ofte n ineffective in the presence of persistently increased flecainide lev els. We report a novel approach to severe flecainide overdose using pe ripheral cardiopulmonary bypass support (CBS) to maintain perfusion of the liver, thereby allowing clearance of the drug. CBS was initiated to resuscitate a young woman who had ingested flecainide in a suicide attempt. The patient had an agonal rhythm, no effective blood pressure , and a flecainide level of 5.4 mu g/ml (therapeutic range, .2 to 1.0 mu g/ml). During 10 hours of CBS, the flecainide level decreased to 1. 4 mu g/ml, a half-life of 6 hours. Effective cardiac rhythm and blood pressure returned. CBS successfully supported this patient until the f lecainide level decreased as a result of redistribution and normal cle arance mechanisms. Unfortunately, because of severe neurologic damage sustained at the time of overdose, the patient died 4 days after admis sion.