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Pneumonitis induced by non-cytotoxic agents
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Umair A Gauhar, J Allen D Cooper
Flecainide is a class 1C antiarrhythmic agent used for the treatment of ventricular and supraventricular arrhythmias. Dyspnoea and chest pain can occur in 4–7 per cent of the patients on flecainide therapy but pulmonary toxicity is much less rare.119 Five cases of suspected flecainide-induced pneumonitis have been described.120–123 Cell-mediated immune responses are thought to be the causative mechanism.120 Withdrawal of the drug and corticosteroid therapy has been helpful. Tocainide, another class 1C antiarrhythmic with a similar structure, has also been reported to cause interstitial pneumonitis.124,125 Amiodarone toxicity is discussed in Chapter 22.
Usefulness of insertable cardiac monitors for risk stratification: current indications and clinical evidence
Published in Expert Review of Medical Devices, 2023
Amira Assaf, Dominic AMJ Theuns, Michelle Michels, Jolien Roos-Hesselink, Tamas Szili-Torok, Sing-Chien Yap
Congenital long QT syndrome (LQTS) is an inherited disease characterized by a prolonged heart-rate corrected QT interval and is associated with an increased risk of malignant ventricular arrhythmias triggered by early afterdepolarizations [47]. The diagnosis is based on a high Schwartz score (≥3.5) and/or the presence of a pathogenic mutation. Pathogenic mutations are found in up to 75% of patients and mainly comprise loss-of-function variants in KCNQ1 and KCNH2, or gain-of-function variants in SCN5A [48,49]. The cornerstone of treatment are beta blockers, preferably non-selective agents (i.e. nadolol and propranolol), and lifestyle measures (i.e. avoidance of QT prolonging drugs, correction of electrolyte abnormalities, avoidance of genotype-specific triggers) [18]. The antiarrhythmic effect of beta blockers is due to the prevention of early afterdepolarizations. In addition, LQT3 patients may benefit from blockers of the late sodium inward current (mexiletine, flecainide or ranolazine) [50]. In patients in whom beta blockers are not effective, not tolerated, not accepted, or contraindicated, left cardiac sympathetic denervation is recommended [17,18].
Ablation for the treatment of Brugada syndrome: current status and future prospects
Published in Expert Review of Medical Devices, 2020
Alessandro Rizzo, Carlo de Asmundis, Pedro Brugada, Mark La Meir, Gian-Battista Chierchia
In subjects without spontaneous type 1 ECG pattern, SCB challenge is commonly used to unmask the ECG pattern. Ajmaline and flecainide are the most commonly used drugs while procainamide is considered less effective [43,46]. Ajmaline, the most effective among SCB, is an alkaloid, classified as a IA antiarrhythmic agent, found in the root of Rauwolfia serpentine which acts by changing the shape and threshold of cardiac action potentials by inhibition of various currents, including INa, Ito or rapid delayed rectifier potassium current (IKr) [47]. Flecainide is a IC antiarrhythmic agent acting on the same channels but considered less sensitive than ajmaline in BrS diagnosis [48].