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

Simon Ermakov; Edward P Gerstenfeld; Yana Svetlichnaya; Melvin M Scheinman

doi:10.1016/j.hrthm.2016.12.010

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

Heart Rhythm. 2017 Apr;14(4):564-569. doi: 10.1016/j.hrthm.2016.12.010. Epub 2016 Dec 9.

Authors

Simon Ermakov¹, Edward P Gerstenfeld², Yana Svetlichnaya², Melvin M Scheinman²

Affiliations

¹ Division of Cardiovascular Medicine, University of California-San Francisco, San Francisco, California. Electronic address: Simon.Ermakov@ucsf.edu.
² Division of Cardiovascular Medicine, University of California-San Francisco, San Francisco, California.

PMID: 27939893
DOI: 10.1016/j.hrthm.2016.12.010

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.

Keywords: Antiarrhythmic therapy; Arrhythmogenic right ventricular cardiomyopathy; Clinical electrophysiology; Combination therapy; Ventricular arrhythmia.

MeSH terms

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

Substances

Anti-Arrhythmia Agents
Sotalol
Metoprolol
Flecainide