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

弗莱卡奈德 儿茶酚胺能多态性室性心动过速 医学 心脏病学 内科学 植入式心律转复除颤器 室性心动过速 麻醉 心动过速 兰尼碱受体2 兰尼定受体 心房颤动 受体
作者
Christian van der Werf,Prince J. Kannankeril,Frédéric Sacher,Andrew D. Krahn,Sami Viskin,Antoine Leenhardt,Wataru Shimizu,Naokata Sumitomo,Frank A. Fish,Zahurul A. Bhuiyan,Albert R. Willems,Maurits J. van der Veen,Hiroshi Watanabe,Julien Laborderie,Michel Haı̈ssaguerre,Bjørn C. Knollmann,Arthur A.M. Wilde
出处
期刊:Journal of the American College of Cardiology [Elsevier]
卷期号:57 (22): 2244-2254 被引量:356
标识
DOI:10.1016/j.jacc.2011.01.026
摘要

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 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. 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.
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