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Thankyou for your informative article. Flecainide is commonly
administered in the accident and emergency department for new onset atrial
fibrillation in young patients with no obvious heart disease.
As you correctly state the risk of proarrthymia is increased in patients
with structural heart disease.However screening for structural heart prior
to administration is not straight forward.High heart rates together with
the noise of a busy A+E department may make detection of valvular heart
disease difficult. Left ventricular hypertophy may be missed by those
those not experienced in electrocardiogram interpretation. Do the authors
believe an echocardiogram should ideally be performed prior to
administration of flecanide in the A+E?