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Flecainide Therapy Reduces Exercise-Induced Ventricular Arrhythmias in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia

Journal of the American College of Cardiology, 2011-05, Vol.57 (22), p.2244-2254 [Peer Reviewed Journal]

American College of Cardiology Foundation ;2011 American College of Cardiology Foundation ;2015 INIST-CNRS ;Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited May 31, 2011 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2011.01.026 ;PMID: 21616285 ;CODEN: JACCDI

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Title:
Flecainide Therapy Reduces Exercise-Induced Ventricular Arrhythmias in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia
Author: van der Werf, Christian, MD ; Kannankeril, Prince J., MD, MSCI ; Sacher, Frederic, MD ; Krahn, Andrew D., MD ; Viskin, Sami, MD ; Leenhardt, Antoine, MD ; Shimizu, Wataru, MD, PhD ; Sumitomo, Naokata, MD ; Fish, Frank A., MD ; Bhuiyan, Zahurul A., MD, PhD ; Willems, Albert R., MD, PhD ; van der Veen, Maurits J., MD, PhD ; Watanabe, Hiroshi, MD, PhD ; Laborderie, Julien, MD ; Haïssaguerre, Michel, MD ; Knollmann, Björn C., MD, PhD ; Wilde, Arthur A.M., MD, PhD
Subjects: Adolescent ; Adult ; Aged ; Anti-Arrhythmia Agents - administration & dosage ; Anti-Arrhythmia Agents - pharmacology ; Anti-Arrhythmia Agents - therapeutic use ; antiarrhythmia agents ; Arrhythmias, Cardiac - prevention & control ; Biological and medical sciences ; Blood ; Cardiac arrhythmia ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Cardiovascular ; catecholaminergic polymorphic ventricular tachycardia ; Child ; Defibrillators ; Defibrillators, Implantable ; Dose-Response Relationship, Drug ; Exercise ; Exercise Test ; Female ; Flecainide - administration & dosage ; Flecainide - pharmacology ; Flecainide - therapeutic use ; Heart ; Heart attacks ; Humans ; Internal Medicine ; Male ; Medical sciences ; Middle Aged ; Retrospective Studies ; Tachycardia, Ventricular - drug therapy ; ventricular arrhythmia ; Young Adult
Is Part Of: Journal of the American College of Cardiology, 2011-05, Vol.57 (22), p.2244-2254
Description: Objectives This study evaluated the efficacy and safety of flecainide in addition to conventional drug therapy in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). Background CPVT is an inherited arrhythmia syndrome caused by gene mutations that destabilize cardiac ryanodine receptor Ca2+ release channels. Sudden cardiac death is incompletely prevented by conventional drug therapy with β-blockers with or without Ca2+ channel blockers. The antiarrhythmic agent flecainide directly targets the molecular defect in CPVT by inhibiting premature Ca2+ release and triggered beats in vitro. Methods We collected data from every consecutive genotype-positive CPVT patient started on flecainide at 8 international centers before December 2009. The primary outcome measure was the reduction of ventricular arrhythmias during exercise testing. Results Thirty-three patients received flecainide because of exercise-induced ventricular arrhythmias despite conventional (for different reasons, not always optimal) therapy (median age 25 years; range 7 to 68 years; 73% female). Exercise tests comparing flecainide in addition to conventional therapy with conventional therapy alone were available for 29 patients. Twenty-two patients (76%) had either partial (n = 8) or complete (n = 14) suppression of exercise-induced ventricular arrhythmias with flecainide (p < 0.001). No patient experienced worsening of exercise-induced ventricular arrhythmias. The median daily flecainide dose in responders was 150 mg (range 100 to 300 mg). During a median follow-up of 20 months (range 12 to 40 months), 1 patient experienced implantable cardioverter-defibrillator shocks for polymorphic ventricular arrhythmias, which were associated with a low serum flecainide level. In 1 patient, flecainide successfully suppressed exercise-induced ventricular arrhythmias for 29 years. Conclusions Flecainide reduced exercise-induced ventricular arrhythmias in patients with CPVT not controlled by conventional drug therapy.
Publisher: New York, NY: Elsevier Inc
Language: English
Identifier: ISSN: 0735-1097
EISSN: 1558-3597
DOI: 10.1016/j.jacc.2011.01.026
PMID: 21616285
CODEN: JACCDI
Source: GFMER Free Medical Journals
MEDLINE
Alma/SFX Local Collection

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Flecainide Therapy Reduces Exercise-Induced Ventricular Arrhythmias in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia

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