Author + information
- María del Val Groba Marco,
- Fernando Wangüemert Pérez,
- Julio Salvador Hernandez Afonso,
- Eduardo Caballero Dorta,
- Luis Alvarez Acosta,
- Oscar Campuzano Larrea,
- Guillermo Javier Pérez,
- Josep Brugada and
- Ramon Brugada-Terradellas
Background: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited disease characterized by ventricular arrhythmias (VA) triggered in a situation of physical or emotional stress in young people with structurally normal heart. The cornerstone of the treatment are the beta-blockers (BB) and it has been recently incorporated flecainide. The aim of this work is to expose our experience with this drug in patients (p.) with CPVT.
Methods: This is a multicenter and ambidirectional study. The cohort included 174 genotype-positive CPVT p. belonging to 7 families who completed the follow-up between 2007 and 2015. We collected data from those p. started on flecainide and analysed the indication, side effects and dosage, as well as the clinical outcomes, exercise-induced VA, arrhythmic window, and cardioverter-defibrillator (ICD) shocks during follow-up.
Results: Eighteen p. (10.4%) received flecainide, 17 p. in combination with BB, and 1 p. as monotherapy due to side effects of BB. No patient presented side effects. In 13 p. (72.2%) the indication was the persistence of complex VA in the exercise-tests and in 5 p. (27.7%) persistent ICD-shocks despite of BB therapy. After starting on flecainide VA burden decreased in all p. In 66.7% of the members of Family 1, the exercise-induced VA quantitative score was reduced by more than 50% in consecutive exercise tests. The arrhythmic window, reflecting the range of heart rate during which arrhythmias occurred, was smaller during treatment with BB and flecainide (5,8+- 11,9 ppm vs 19,69+- 21,27; p=0,007). In 4 of 5 p. with appropriate ICD-shock did not suffer any in the follow-up.
Conclusions: Flecainide in combination with a BB reduces symptoms, exercise-induced VA, the arrhythmic window, and ICD shocks. This study demonstrates that this drug is safe and effective in patients not controlled by conventional drug therapy. Unlike other data in recent studies, these results show an excellent tolerance to the antiarrythmic drug, as well as more benign clinical course after starting on flecainide. This maybe due to a regular follow up with repeated execise tests for a progressive up-tritation of both the beta-blocker and the flecainide.
Moderated Poster Contributions
Arrhythmias and Clinical EP Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-3:55 p.m.
Session Title: Cardiac Channelopathies: Novel Therapeutics and Clinical Challenges
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1262M-03
- 2017 American College of Cardiology Foundation