Is flecainide effective in patients with CPVT?

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a heritable disease in which abnormal and life-threatening heart rhythms occur during exercise or heightened emotion (such as anger or excitement). Patients with this condition are often treated with beta-blocker medication . In some cases, however, beta-blocker medication alone is not enough to stop the abnormal heart rhythms and take away the symptoms of CPVT.

In this study, we investigated how effective  use of both  beta-blocker and flecainide medication  are when compared to use of a beta-blocker alone. We looked back in existing patient information (patient files) and included CPVT patients from two international registries who were treated first with beta-blockers alone, and  where flecainide was added to their beta-blocker treatment later. We compared the number of life-threatening events (i.e. sudden cardiac arrest, black-out, or shock from an implanted defibrillator) in both treatment periods to   understand if adding flecainide is effective. During these treatment periods, other treatments for CPVT had to stay the same, so as to compare them fairly.

In total, we included 247 patients. We found that during the ‘beta-blocker medication alone’ treatment period, patients had more life-threatening events than during the ‘beta-blocker and flecainide’ medication treatment period. This effect was more  noticeable in the subgroup of patients who  still had symptoms on beta-blocker medication alone. We feel that adding flecainide to beta-blocker treatment  appears to work better in patients with CPVT.

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Bergeman AT, Lieve KVV, Kallas D, Bos JM, Rosés I Noguer F, Denjoy I, Zorio E, Kammeraad JAE, Peltenburg PJ, Tobert K, Aiba T, Atallah J, Drago F, Batra AS, Brugada R, Borggrefe M, Clur SB, Cox MGPJ, Davis A, Dhillon S, Etheridge SP, Fischbach P, Franciosi S, Haugaa K, Horie M, Johnsrude C, Kane AM, Krause U, Kwok SY, LaPage MJ, Ohno S, Probst V, Roberts JD, Robyns T, Sacher F, Semsarian C, Skinner JR, Swan H, Tavacova T, Tisma-Dupanovic S, Tfelt-Hansen J, Yap SC, Kannankeril PJ, Leenhardt A, Till J, Sanatani S, Tanck MWT, Ackerman MJ, Wilde AAM, van der Werf C. Flecainide Is Associated With a Lower Incidence of Arrhythmic Events in a Large Cohort of Patients With Catecholaminergic Polymorphic Ventricular Tachycardia.

Circulation. 2023 Dec 19;148(25):2029-2037. PMID: 37886885