What is the clinical evidence from this study?

Study design: Other. Population: Right ventricular tachycardia without overt cardiac abnormality (n=23). Intervention: Flecainide, sotalol, and verapamil vs. Drug-free baseline. Primary outcome: Number of ventricular events on 24-hour Holter monitoring, and tachycardia inducibility by treadmill exercise and programmed ventricular stimulation (p=<0.01).

October 1, 1992Open Access

Efficacy of flecainide, sotalol, and verapamil in the treatment of right ventricular tachycardia in patients without overt cardiac abnormality

Q: What are the key findings of this study?

Flecainide, sotalol, and verapamil all significantly suppressed right ventricular tachycardia compared to drug-free baseline (p 89% of patients).

JGJas GillGuy's and St Thomas' NHS Foundation Trust DMDavendra MehtaMount Sinai Hospital DWD. E. WardRamapo College

Key Result

Flecainide, sotalol, and verapamil all significantly suppressed right ventricular tachycardia compared to drug-free baseline (p<0.01), with sotalol being the most frequently effective (>89% of patients).

Structured PICO

Do flecainide, sotalol, and verapamil suppress right ventricular tachycardia in patients with a clinically normal heart compared to baseline?

Population

23 patients with right ventricular tachycardia and a clinically normal heart who underwent serial testing with verapamil, sotalol, and flecainide.

Intervention

Serial treatment with oral verapamil (360 mg daily), sotalol (240 or 320 mg daily), and flecainide (200 or 300 mg daily), each given for five half-lives before testing

Comparator

Drug-free baseline tests

Outcome

Number of ventricular events on 24 hour Holter monitoring, and the ability of tachycardia to be induced by treadmill exercise testing (Bruce protocol) and programmed ventricular stimulation (Wellens protocol)surrogate

Flecainide, sotalol, and verapamil are all effective in suppressing right ventricular tachycardia in patients with structurally normal hearts, with sotalol being a suitable first-line choice.

Main Result

p-value: p=<0.01

Abstract

OBJECTIVE: A comparison of the efficacy of verapamil, sotalol, and flecainide to suppress right ventricular tachycardia (VT) in patients with a clinically normal heart. DESIGN: Patients underwent treatment serially with verapamil (360 mg daily), sotalol (240 or 320 mg daily), and flecainide (200 or 300 mg daily), (the larger dose was for patients heavier than 80 kg) to suppress tachycardia. Each drug was given orally for five half lives before testing. PATIENTS: 23 patients with right VT associated with a clinically normal heart were studied. OUTCOME MEASURES: The effects of drug treatment were examined by the number of ventricular events on 24 hour Holter monitoring, and the ability of tachycardia to be induced by treadmill exercise testing (Bruce protocol) and programmed ventricular stimulation (Wellens protocol), compared with drug free baseline tests. SETTING: Patients were studied in a tertiary referral centre. RESULTS: All three drugs suppressed ventricular salvos (> 3, 89% of patients) and is a suitable choice for first line treatment.

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