Hemoperfusion in flecainide poisoning

: A 79-year-old patient, who had received a pacemaker after suffering two posterior myocardial infarctions, was treated with 2 X 100 mg flecainide daily for 9 days for ventricular extrasystoles (Lown IV b). On admission to the hospital the parameters of renal function were within the normal range. Ten days after flecainide treatment was begun a temporary electromechanic decoupling of the pacemaker occurred with reversible asystoly and progressive kidney failure. The flecainide plasma level at that time was 1460 ng/ml. Hemoperfusion for 3 h with activated charcoal removed only 35 mg flecainide in spite of an excellent flecainide clearance (164-180 ml/min). The patient's flecainide plasma level did not decrease sufficiently during the procedure, showing clearly that flecainide levels cannot be lowered fast enough by hemoperfusion to treat a flecainide intoxication.