Why the study?
Owing to recurrent cardiac events in some CPVT patients using β-blockers, safer alternatives were investigated, as flecainide is an alternative adjunctive anti-arrhythmic agent known to provide incomplete protection.
Does flecainide monotherapy or combination therapy with β-blockers reduce arrhythmic events and exercise-induced arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia?
Does flecainide monotherapy or combination therapy with β-blockers reduce arrhythmic events and exercise-induced arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia?
Flecainide, either as monotherapy or in combination with β-blockers, significantly reduces the risk of arrhythmic events and exercise-induced arrhythmias in patients with CPVT.
May support adjunctive flecainide in refractory CPVT; leaves open confirmation by prospective trials.
BACKGROUND: Owing to reports of recurrent cardiac events in some catecholaminergic polymorphic ventricular tachycardia (CPVT) patients using β-blockers, safer alternatives are being investigated. Flecainide is an alternative adjunctive anti-arrhythmic agent known to provide incomplete protection to CPVT patients. METHODS: To investigate the efficacy and tolerability of flecainide, we searched 4 databases for retrospective cohort studies (RCs) and randomized controlled trials (RCTs) investigating the efficacy and safety of flecainide for CPVT patients. Data were extracted and analyzed (risk ratio [RR] or mean difference [MD]) using RevMan software. Seven RCs and 1 RCT (333 CPVT patients; 152 patients treated with flecainide) were identified. RESULTS: Flecainide monotherapy was superior to standard therapy in alleviating the risk of arrhythmic events (RR = 0.46, confidence interval [CI] = [0.38, 0.56], P < .00001) and exercise-induced arrhythmia scores (MD = -0.39, CI = [-0.74, -0.05], P = .03). Combination therapy of flecainide and β-blockers was superior to β-blocker monotherapy in reducing the risk of arrhythmic and symptomatic events (RR = 0.29, CI = [0.13, 0.69], P = .005; RR = 0.36, CI = [0.20, 0.62], P = .0003, respectively), peak heart rate (MD = -16.81, CI = [-28.21, -5.41], P = .004), and exercise-induced arrhythmia scores (MD = -1.87, CI = [-2.71, 1.04], P < .0001). Flecainide did not increase the risk of all side effects (RR = 0.76, CI = [0.42, 1.40], P = .38) compared to that with β-blockers alone. No deaths were reported among patients treated with flecainide. CONCLUSIONS: Flecainide is an effective and safe anti-arrhythmic agent, and its use as a monotherapy might be a good alternative for CPVT patients with β-blocker intolerance. Combination therapy was superior to β-blocker monotherapy. More randomized clinical trials are required to explore the long-term efficacy and safety of flecainide in these patients.
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Wang et al. (2019) studied this question.
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