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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

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Titel: Flecainide Is Associated With a Lower Incidence of Arrhythmic Events in a Large Cohort of Patients With Catecholaminergic Polymorphic Ventricular Tachycardia
Autoren: Auke T. Bergeman, Krystien V.V. Lieve, Dania Kallas, J. Martijn Bos, Ferran Rosés i Noguer, Isabelle Denjoy, Esther Zorio, Janneke A.E. Kammeraad, Puck J. Peltenburg, Katie Tobert, Takeshi Aiba, Joseph Atallah, Fabrizio Drago, Anjan S. Batra, Ramon Brugada, Martin Borggrefe, Sally-Ann B. Clur, Moniek G.P.J. Cox, Andrew Davis, Santokh Dhillon, Susan P. Etheridge, Peter Fischbach, Sonia Franciosi, Kristina Haugaa, Minoru Horie, Christopher Johnsrude, Austin M. Kane, Ulrich Krause, Sit-Yee Kwok, Martin J. LaPage, Seiko Ohno, Vincent Probst, Jason D. Roberts, Tomas Robyns, Frederic Sacher, Christopher Semsarian, Jonathan R. Skinner, Heikki Swan, Terezia Tavacova, Svjetlana Tisma-Dupanovic, Jacob Tfelt-Hansen, Sing-Chien Yap, Prince J. Kannankeril, Antoine Leenhardt, Janice Till, Shubhayan Sanatani, Michael W.T. Tanck, Michael J. Ackerman, Arthur A.M. Wilde, Christian van der Werf
Weitere Verfasser: Institut Català de la Salut, [Bergeman AT, Lieve KVV] Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, The Netherlands. Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, The Netherlands. [Kallas D] Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada. [Bos JM] Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN. [Rosés i Noguer F] Department of Cardiology, Royal Brompton Hospital, London, United Kingdom. Servei de Cardiologia Pediàtrica, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Denjoy I] Service de Cardiologie et CRMR Maladies Cardiaques Héréditaires et Rares, APHP, Hôpital Bichat, Université Paris Cité, France, Vall d'Hebron Barcelona Hospital Campus, Clinicum, HUS Heart and Lung Center, Bergeman, Auke T., Lieve, Krystien V.V., Kallas, Dania, Bos, Johan M., Noguer, Ferran Roses y, Denjoy, Isabelle, Zorio, Esther, Kammeraad, Janneke A.E., Peltenburg, P.J., Tobert, Katie, van der Werf, Christian
Quelle: Circulation
Scientia
Scientia. Dipòsit d'Informació Digital del Departament de Salut
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r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe
Instituto de Investigación Sanitaria La Fe (IIS La Fe)
Bergeman, A T, Lieve, K V V, Kallas, D, Bos, J M, Rosés I Noguer, F, Denjoy, I, Zorio, E, Kammeraad, J A E, Peltenburg, P J, Tobert, K, Aiba, T, Atallah, J, Drago, F, Batra, A S, Brugada, R, Borggrefe, M, Clur, S-A B, Cox, M G P J, Davis, A, Dhillon, S, Etheridge, S P, Fischbach, P, Franciosi, S, Haugaa, K, Horie, M, Johnsrude, C, Kane, A M, Krause, U, Kwok, S-Y, LaPage, M J, Ohno, S, Probst, V, Roberts, J D, Robyns, T, Sacher, F, Semsarian, C, Skinner, J R, Swan, H, Tavacova, T, Tisma-Dupanovic, S, Tfelt-Hansen, J, Yap, S-C, Kannankeril, P J, Leenhardt, A, Till, J, Sanatani, S, Tanck, M W T, Ackerman, M J, Wilde, A A M & van der Werf, C 2023, ' Flecainide Is Associated With a Lower Incidence of Arrhythmic Events in a Large Cohort of Patients With Catecholaminergic Polymorphic Ventricular Tachycardia ', Circulation, vol. 148, no. 25, pp. 2029-2037 . https://doi.org/10.1161/CIRCULATIONAHA.123.064786
Circulation, vol 148, iss 25
Verlagsinformationen: Ovid Technologies (Wolters Kluwer Health), 2023.
Publikationsjahr: 2023
Schlagwörter: Male, Cardiac & Cardiovascular Systems, CHILDREN, Flecainide/adverse effects, Tachycardia, Original Research Articles, Tachycardia, Ventricular/diagnosis, 1102 Cardiorespiratory Medicine and Haematology, 4207 Sports science and exercise, Adrenergic beta-Antagonists/adverse effects, Flecainide, Cross-Over Studies, catecholaminergic polymorphic ventricular tachycardia, CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Cardiovascular Agents::Anti-Arrhythmia Agents, RYANODINE RECEPTOR, Incidence, Antiarítmics cardíacs - Ús terapèutic, Arrítmia - Tractament, General medicine, internal medicine and other clinical medicine, 3. Good health, Defibrillators, Implantable, Death, Female, Implantable, Ventricular/diagnosis, Cardiac/epidemiology, 3201 Cardiovascular medicine and haematology, Cardiac, Life Sciences & Biomedicine, Adolescent, Adrenergic beta-Antagonists, INHIBITION, DISEASES::Cardiovascular Diseases::Heart Diseases::Arrhythmias, Cardiac::Tachycardia::Tachycardia, Ventricular, sudden cardiac death, 1117 Public Health and Health Services, ENFERMEDADES::enfermedades cardiovasculares::enfermedades cardíacas::arritmias cardíacas::taquicardia::taquicardia ventricular, COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::fármacos cardiovasculares::antiarrítmicos, Humans, Polymorphic Catecholaminergic Ventricular Tachycardia, Death, Sudden, Cardiac/epidemiology, Science & Technology, ventricular arrhythmias, Ventricular, 3202 Clinical sciences, 1103 Clinical Sciences, Sudden, Cor - Malalties - Tractament, Death, Sudden, Cardiac, Peripheral Vascular Disease, Cardiovascular System & Hematology, Cardiovascular System & Cardiology, Tachycardia, Ventricular, Defibrillators
Beschreibung: 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 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.
Publikationsart: Article
Other literature type
Dateibeschreibung: application/pdf
Sprache: English
ISSN: 1524-4539
0009-7322
DOI: 10.1161/circulationaha.123.064786
Zugangs-URL: https://pubmed.ncbi.nlm.nih.gov/37886885
https://hdl.handle.net/11351/10889
https://fundanet.iislafe.san.gva.es/publicaciones/ProdCientif/PublicacionFrw.aspx?id=19780
https://lirias.kuleuven.be/handle/20.500.12942/751038
https://doi.org/10.1161/circulationaha.123.064786
http://hdl.handle.net/10138/569552
https://resolver.sub.uni-goettingen.de/purl?gro-2/138806
https://curis.ku.dk/ws/files/381506977/bergeman_et_al_2023_flecainide_is_associated_with_a_lower_incidence_of_arrhythmic_events_in_a_large_cohort_of_patients.pdf
https://escholarship.org/content/qt8q02z3r9/qt8q02z3r9.pdf
https://escholarship.org/uc/item/8q02z3r9
Rights: CC BY
URL: http://creativecommons.org/licenses/by/4.0/Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
Dokumentencode: edsair.doi.dedup.....b3578a71736b954330f23d1108c382f3
Datenbank: OpenAIRE
Beschreibung
Abstract: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 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.
ISSN:15244539
00097322
DOI:10.1161/circulationaha.123.064786