Hemodynamic effects of intravenous flecainide relative to the level of ventricular function in patients with coronary artery disease

Flecainide, a new antiarrhythmic agent with poorly defined hemodynamic actions, was studied in 22 patients with coronary artery disease. Intravenous infusions of 1 mg/kg and 2 mg/kg resulted in respective increases in right atrial pressure (12%, p < 0.05; 15%, p < 0.01), mean pulmonary artery pressure (27%, p < 0.01; 28%, p < 0.01), and pulmonary capillary wedge pressure (44%, p < 0.05; 33%, p < 0.01). Cardiac index decreased 8% (p < 0.05) after 1 mg/kg flecainide and 12% (p < 0.05) after the 2 mg/kg dose. The mean left ventricular ejection fraction decreased by 15% (p < 0.01) and 16% (p < 0.01), respectively, 10 minutes after 1 mg/kg and 2 mg/kg of flecainide. Minimal increases in the heart rate (< 5%) and no significant change in arterial pressure occurred 5 to 10 minutes after flecainide and were associated with borderline and variable increases in pulmonary and systemic vascular resistances. Flecainide diluent did not induce changes in pulmonary capillary wedge pressure or left ventricular ejection fraction. Thus, flecainide exerts a moderate but significant negative inotropic effect which may be clinically significant in patients with severely compromised ventricular function.