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European Heart Journal 1985 6(8):664-671;
Copyright © 1985 by the European Society of Cardiology.
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© 1985 The European Society of Cardiology

Comparative haemodynamic effects of intravenous flecainide in patients with and without heart failure and with and without beta-blocker therapy

V. LEGRAND1,, P. MATERNE1, M. VANDORMAEL1, P. COLLIGNON1 and H. E. KULBERTUS1

1Section of Cardiology, School of Medicine, University of Liège Liège, Belgium

Received 12 December 1984; revised 3 May 1985; .

Address for correspondence. Victor Legrand, Section of Cardiology, School of Medicine, University of Liège, Bd de la Constitution 66, 4020 Liège, Belgium.

Abstract

The haemodynamic effects of flecainide were compared in three different subsets of patients with documented coronary disease. Ten patients (A) had no heart failure, 5 patients were on beta blockers (B) and 5 patients had overt heart failure (C). Flecainide was associated with negative inotropic effects that were relatively more pronounced in patients with left ventricular dysfunction: pulmonary wedge pressure increased by 27% in A, by 31% in B and by 42% in C; left ventricular stroke volume and stroke work decreased respectively by 10 and 12% in A, 21 and 19% in B, 26 and 28% in C. Ejection fraction decreased by 9% in A, 13% in B and 20% in C, in relation with an increase in end systolic volume ( + 9% in A, +10% in Band + 5%inC).

Absolute changes, however, were not significantly different from one group to another except for the increase of systemic vascular resistance which was more pronounced in C as compared with the other groups. The myocardial depression was also confirmed by the fall in dPjdt that was maximal at the end of injection; dP/dt remained depressed 15 min later despite some improvement. Flecainide thus exerts negative inotropic effects that are maximal at the end of infusion and may be of importance in patients with established left ventricular dysfunction.

Key Words: Flecainide • haemodynamics • coronary artery disease


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