Credentials ultimately matter less than what you do with them. I spend my days working alongside colleagues who did their medical education abroad from whom I'm constantly learning. Meanwhile, Dr. Oz went to Penn. FL's Ladapo went to HMS, too. They'd be alarming choices too.

Appreciate your point about flecainide toxicity often presenting with QRS widening and MMVT, but this still seems less likely here. Thanks for the insights!

Your differentials of hyperkalemia (e.g., from aldactone or AKI), drug interaction elevating antiarrhythmic levels, and epicardial VT induction from BiV pacing are all valid considerations, though epicardial VT is less likely given consistent pacing spikes.

You're right—flecainide is specifically contraindicated in post-MI patients, and its use in other structural heart diseases, like MVP, has shown good outcomes. As you noted, the spike preceding the QRS confirms this is a paced rhythm, not true MMVT...

Flecainide is contraindicated in structural heart disease and usually causes polymorphic VT or VF rather than monomorphic VT.

While there's QRS widening, this is typical of monomorphic VT, not the extreme QRS prolongation you'd expect.

Amiodarone?

I'm not a writer, but I am interested.

Thank you for this!