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Flecainide Is Associated With a Lower Incidence of Arrhythmic Events in a Large Cohort of Patients With Catecholaminergic Polymorphic Ventricular Tachycardia
AT. Bergeman, KVV. Lieve, D. Kallas, JM. Bos, F. Rosés I Noguer, I. Denjoy, E. Zorio, JAE. Kammeraad, PJ. Peltenburg, K. Tobert, T. Aiba, J. Atallah, F. Drago, AS. Batra, R. Brugada, M. Borggrefe, SB. Clur, MGPJ. Cox, A. Davis, S. Dhillon, SP....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu multicentrická studie, časopisecké články
NLK
Free Medical Journals
od 1950 do Před 1 rokem
Open Access Digital Library
od 1950-01-01
Open Access Digital Library
od 1950-01-01
- MeSH
- beta blokátory škodlivé účinky MeSH
- defibrilátory implantabilní * MeSH
- flekainid škodlivé účinky MeSH
- incidence MeSH
- klinické křížové studie MeSH
- komorová tachykardie * diagnóza farmakoterapie epidemiologie MeSH
- lidé MeSH
- mladiství MeSH
- náhlá srdeční smrt epidemiologie etiologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: In severely affected patients with catecholaminergic polymorphic ventricular tachycardia, beta-blockers are often insufficiently protective. The purpose of this study was to evaluate whether flecainide is associated with a lower incidence of arrhythmic events (AEs) when added to beta-blockers in a large cohort of patients with catecholaminergic polymorphic ventricular tachycardia. METHODS: From 2 international registries, this multicenter case cross-over study included patients with a clinical or genetic diagnosis of catecholaminergic polymorphic ventricular tachycardia in whom flecainide was added to beta-blocker therapy. The study period was defined as the period in which background therapy (ie, beta-blocker type [beta1-selective or nonselective]), left cardiac sympathetic denervation, and implantable cardioverter defibrillator treatment status, remained unchanged within individual patients and was divided into pre-flecainide and on-flecainide periods. The primary end point was AEs, defined as sudden cardiac death, sudden cardiac arrest, appropriate implantable cardioverter defibrillator shock, and arrhythmic syncope. The association of flecainide with AE rates was assessed using a generalized linear mixed model assuming negative binomial distribution and random effects for patients. RESULTS: A total of 247 patients (123 [50%] females; median age at start of flecainide, 18 years [interquartile range, 14-29]; median flecainide dose, 2.2 mg/kg per day [interquartile range, 1.7-3.1]) were included. At baseline, all patients used a beta-blocker, 70 (28%) had an implantable cardioverter defibrillator, and 21 (9%) had a left cardiac sympathetic denervation. During a median pre-flecainide follow-up of 2.1 years (interquartile range, 0.4-7.2), 41 patients (17%) experienced 58 AEs (annual event rate, 5.6%). During a median on-flecainide follow-up of 2.9 years (interquartile range, 1.0-6.0), 23 patients (9%) experienced 38 AEs (annual event rate, 4.0%). There were significantly fewer AEs after initiation of flecainide (incidence rate ratio, 0.55 [95% CI, 0.38-0.83]; P=0.007). Among patients who were symptomatic before diagnosis or during the pre-flecainide period (n=167), flecainide was associated with significantly fewer AEs (incidence rate ratio, 0.49 [95% CI, 0.31-0.77]; P=0.002). Among patients with ≥1 AE on beta-blocker therapy (n=41), adding flecainide was also associated with significantly fewer AEs (incidence rate ratio, 0.25 [95% CI, 0.14-0.45]; P<0.001). CONCLUSIONS: For patients with catecholaminergic polymorphic ventricular tachycardia, adding flecainide to beta-blocker therapy was associated with a lower incidence of AEs in the overall cohort, in symptomatic patients, and particularly in patients with breakthrough AEs while on beta-blocker therapy.
Agnes Ginges Centre for Molecular Cardiology at Centenary Institute University of Sydney Australia
Amsterdam Cardiovascular Sciences Heart Failure and Arrhythmias The Netherlands
Center for Biomedical Network Research on Cardiovascular Diseases Madrid Spain
Department of Cardiology Erasmus MC University Medical Center Rotterdam The Netherlands
Department of Cardiology Hospital Universitario y Politécnico La Fe Valencia Spain
Department of Cardiology Rigshospitalet Copenhagen Denmark
Department of Cardiology Royal Brompton Hospital London United Kingdom
Department of Cardiology University of Groningen University Medical Centre Groningen The Netherlands
Department of Cardiovascular Diseases University Hospitals Leuven Belgium
Department of Cardiovascular Medicine Shiga University of Medical Science Otsu Japan
Department of Medicine University Medical Center Mannheim Germany
Department of Paediatric Cardiology Vall d'Hebron University Hospital Barcelona Spain
Department of Paediatrics Hong Kong Children's Hospital China
Department of Pediatric Cardiology Erasmus MC Sophia Rotterdam The Netherlands
Department of Pediatrics BC Children's Hospital University of British Columbia Vancouver Canada
Department of Pediatrics University of Alberta Edmonton Canada
Department of Pediatrics University of California Irvine
Division of Cardiology Children's Mercy Hospital Kansas City MO
Division of Pediatric Cardiology University of Utah Salt Lake City
European Reference Network for Rare Low Prevalence and Complex Diseases of the Heart ERN GUARD Heart
Heart and Lung Centre Helsinki University Hospital and Helsinki University Finland
IWK Health Center Dalhousie University Halifax Canada
LIRYC Institute Bordeaux University Hospital Bordeaux University France
Medical Genome Center National Cerebral and Cardiovascular Center Suita Japan
Sibley Heart Center Children's Healthcare of Atlanta GA
The Royal Children's Hospital Melbourne Australia
Université de Nantes CHU Nantes CNRS INSERM L'institut du Thorax France
Citace poskytuje Crossref.org
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- $a Flecainide Is Associated With a Lower Incidence of Arrhythmic Events in a Large Cohort of Patients With Catecholaminergic Polymorphic Ventricular Tachycardia / $c AT. Bergeman, KVV. Lieve, D. Kallas, JM. Bos, F. Rosés I Noguer, I. Denjoy, E. Zorio, JAE. Kammeraad, PJ. Peltenburg, K. Tobert, T. Aiba, J. Atallah, F. Drago, AS. Batra, R. Brugada, M. Borggrefe, SB. Clur, MGPJ. Cox, A. Davis, S. Dhillon, SP. Etheridge, P. Fischbach, S. Franciosi, K. Haugaa, M. Horie, C. Johnsrude, AM. Kane, U. Krause, SY. Kwok, MJ. LaPage, S. Ohno, V. Probst, JD. Roberts, T. Robyns, F. Sacher, C. Semsarian, JR. Skinner, H. Swan, T. Tavacova, S. Tisma-Dupanovic, J. Tfelt-Hansen, SC. Yap, PJ. Kannankeril, A. Leenhardt, J. Till, S. Sanatani, MWT. Tanck, MJ. Ackerman, AAM. Wilde, C. van der Werf
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