Flecainide therapy reduces exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia.

Details

Serval ID
serval:BIB_5A645A34E429
Type
Article: article from journal or magazin.
Collection
Publications
Title
Flecainide therapy reduces exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia.
Journal
Journal of the American College of Cardiology
Author(s)
van der Werf C., Kannankeril P.J., Sacher F., Krahn A.D., Viskin S., Leenhardt A., Shimizu W., Sumitomo N., Fish F.A., Bhuiyan Z.A., Willems A.R., van der Veen M.J., Watanabe H., Laborderie J., Haïssaguerre M., Knollmann B.C., Wilde A.A.
ISSN
1558-3597 (Electronic)
ISSN-L
0735-1097
Publication state
Published
Issued date
31/05/2011
Peer-reviewed
Oui
Volume
57
Number
22
Pages
2244-2254
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
This study evaluated the efficacy and safety of flecainide in addition to conventional drug therapy in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT).
CPVT is an inherited arrhythmia syndrome caused by gene mutations that destabilize cardiac ryanodine receptor Ca(2+) release channels. Sudden cardiac death is incompletely prevented by conventional drug therapy with β-blockers with or without Ca(2+) channel blockers. The antiarrhythmic agent flecainide directly targets the molecular defect in CPVT by inhibiting premature Ca(2+) release and triggered beats in vitro.
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.
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.
Flecainide reduced exercise-induced ventricular arrhythmias in patients with CPVT not controlled by conventional drug therapy.

Keywords
Adolescent, Adult, Aged, Anti-Arrhythmia Agents/administration & dosage, Anti-Arrhythmia Agents/pharmacology, Anti-Arrhythmia Agents/therapeutic use, Arrhythmias, Cardiac/prevention & control, Child, Defibrillators, Implantable, Dose-Response Relationship, Drug, Exercise Test, Female, Flecainide/administration & dosage, Flecainide/pharmacology, Flecainide/therapeutic use, Humans, Male, Middle Aged, Retrospective Studies, Tachycardia, Ventricular/drug therapy, Young Adult
Pubmed
Web of science
Open Access
Yes
Create date
01/03/2018 16:23
Last modification date
20/08/2019 15:13
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