Use of flecainide in combination antiarrhythmic therapy in patients with arrhythmogenic right ventricular cardiomyopathy.

Abstract

BACKGROUND:

Antiarrhythmic therapy is commonly used for suppression of arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) in conjunction with implantable cardioverter-defibrillators and catheter ablation. The efficacy of combination flecainide and sotalol/metoprolol therapy for patients refractory to single agents and/or catheter ablation has not been well established.

OBJECTIVE:

The purpose of this study was to describe our experience with the addition of flecainide in combination with sotalol/metoprolol for treatment of arrhythmias in patients with ARVC.

METHODS:

We reviewed all patients within our genetic arrhythmia program with a definite diagnosis of ARVC (45 patients) and identified 8 patients treated with a combination of flecainide with sotalol/metoprolol after failure of single-agent therapy and/or catheter ablation. These patients were monitored with at least yearly clinic visits and device interrogations focused on the detection of major ventricular arrhythmias.

RESULTS:

Of the 8 patients reviewed, 6 demonstrated excellent arrhythmia control after initiation of combination therapy with flecainide and sotalol/metoprolol. These patients have been arrhythmia-free for an average of 35.5 months. Two patients have demonstrated recurrent arrhythmias despite combination therapy and have undergone repeat epicardial and endocardial ablation. Recurrence was noted to occur within 2 months of therapy. Patients were diverse with regard to the severity of disease as well as in the presence of genetic mutations.

CONCLUSION:

The addition of flecainide in combination with sotalol/metoprolol may be an effective antiarrhythmic strategy for the control of ventricular arrhythmias in patients with ARVC refractory to single-agent therapy and/or catheter ablation.

• Authors: Simon Ermakov, Edward P Gerstenfeld, Yana Svetlichnaya, Melvin M Scheinman
• Journal: Heart rhythm (Heart Rhythm) Vol. 14 Issue 4 Pg. 564-569 (04 2017) ISSN: 1556-3871 [Electronic] United States
• PMID: 27939893 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anti-Arrhythmia Agents
• Sotalol
• Metoprolol
• Flecainide

Topics

• Adult
• Anti-Arrhythmia Agents (administration & dosage, adverse effects)
• Arrhythmogenic Right Ventricular Dysplasia (diagnosis, physiopathology, therapy)
• Catheter Ablation (adverse effects, methods)
• Combined Modality Therapy (methods)
• Drug Monitoring (methods, statistics & numerical data)
• Drug Therapy, Combination (methods)
• Electrophysiologic Techniques, Cardiac (methods)
• Female
• Flecainide (administration & dosage, adverse effects)
• Humans
• Male
• Metoprolol (administration & dosage, adverse effects)
• Middle Aged
• Recurrence
• Sotalol (administration & dosage, adverse effects)
• Treatment Outcome