Irreversible third-degree heart block and pacemaker implant in a case of flecainide toxicity

An 82-year-old white woman was seen in the emergency department (ED) after ingesting 400 mg of flecainide in an attempt to treat an episode of dizziness and palpitations that occurred while she was gardening. Consequently, she developed bradycardia, hypotension, and complete heart block. In addition to supportive care, she also received sodium bicarbonate, atropine, calcium gluconate, and dopamine in an effort to reverse the heart block. The patient continued to remain in heart block and was sent to the cardiac catheterization laboratory for placement of an external pacing wire, which stabilized the patient. After further evaluation, a permanent pacemaker was implanted during her admission. External pacing wires may be useful in the treatment of complete heart block in cases of flecainide poisoning when a patient is unresponsive to drug therapy provided in the ED.