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Flecainide use in children with congenital heart disease or cardiomyopathy


Flecainide ( Almarytm, Tambocor ) is frequently used for treatment of cardiac arrhythmias in children. Due to concerns regarding increased mortality, there has been hesitancy to use Flecainide in children with congenital heart disease ( CHD ) or cardiomyopathy ( CM ).

The objective of a study was to describe trends in use of Flecainide in children with congenital heart disease or cardiomyopathy and assess its association with cardiac arrest or death.

Data from 42 children's hospitals contained in the PHIS database ( 2004-2011 ) were analyzed. All patients with congenital heart disease or cardiomyopathy receiving anti-arrhythmic therapy for supraventricular arrhythmias were reviewed.
Trends in Flecainide use were analyzed, and the incidence of cardiac arrest or death was compared to patients receiving other antiarrhythmics.

There were 3,544 pts with congenital heart disease or cardiomyopathy who received anti-arrhythmic therapy ( median age 73 days ).
Flecainide was administered in 229 patients ( 6.5 % ).

There was a trend toward increased use of Flecainide in this population, increasing from 4.6 % in 2004 to 8.7 % in 2011 ( p = 0.07 ).

The incidence of cardiac arrest in patients with congenital heart disease or cardiomyopathy receiving Flecainide was 3.0 % with an overall mortality of 4.3 %.
The mortality was 2.9 % in patients with cardiomyopathy and nobody with single ventricle physiology died.

Based on multivariable analysis, when compared to patients with congenital heart disease or cardiomyopathy receiving other antiarrhythmics, there was no difference in the incidence of cardiac arrest ( p = 0.31 ) or death ( p = 0.28 ).

The incidence of cardiac arrest or death with Flecainide administration in this cohort appears comparable to other antiarrhythmic agents. ( Xagena )

Moffett BS et al, Pediatr Cardiol 2014; Epub ahead of print

XagenaMedicine_2014



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