Class IC antiarrhythmic drugs for suspected premature ventricular contraction–induced cardiomyopathy

Hyman, Matthew C.; Mustin, Danielle E.; Supple, Gregory E.; Schaller, Robert D.; Santangeli, Pasquale; Arkles, Jeffrey; Lin, David; Muser, Daniele; Dixit, Sanjay; Nazarian, Saman; Epstein, Andrew E.; Callans, David J.; Marchlinski, Francis E.; Frankel, David S.

doi:10.1016/j.hrthm.2017.12.018

Cited by 70 publications

(51 citation statements)

References 26 publications

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“…Their study found that 1C AADs effectively suppressed PVCs, leading to LVEF recovery in the majority. In addition, no adverse events were observed during the treatment 11 . That analysis, and the results of the current investigation, support the argument for reassessing the safety of 1C AADs in patients without MI but with structural heart disease.…”

Section: Discussionsupporting

confidence: 84%

Class 1C antiarrhythmic drugs in atrial fibrillation and coronary artery disease

Pantlin

Bober

Bernard

et al. 2020

Cardiovasc electrophysiol

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Background Class 1C antiarrhythmic drugs (AADs) are effective first‐line agents for atrial fibrillation (AF) treatment. However, these agents commonly are avoided in patients with known coronary artery disease (CAD), due to known increased risk in the postmyocardial infarction population. Whether 1C AADs are safe in patients with CAD but without clinical ischemia or infarct is unknown. Reduced coronary flow capacity (CFC) on positron emission tomography (PET) reliably identifies myocardial regions supplied by vessels with CAD causing flow limitation. Objective To assess whether treatment with 1C AADs increases mortality in patients without known CAD but with CFC indicating significantly reduced coronary blood flow. Methods In this pilot study, we compared patients with AF and left ventricular ejection fraction ≥50% who were treated with 1C AADs to age‐matched AF patients without 1C AAD treatment. No patient had clinically evident CAD (ie, reversible perfusion defect, known ≥70% epicardial lesion, percutaneous coronary intervention, coronary artery bypass grafting, or myocardial infarction). All patients had PET‐based quantification of stress myocardial blood flow and CFC. Death was assessed by clinical follow‐up and social security death index search. Results A total of 78 patients with 1C AAD exposure were matched to 78 controls. Over a mean follow‐up of 2.0 years, the groups had similar survival (P = .54). Among patients with CFC indicating the presence of occult CAD (ie, reduced CFC involving ≥50% of myocardium), 1C‐treated patients had survival similar to (P = .44) those not treated with 1C agents. Conclusions In a limited population of AF patients with preserved left ventricle function and PET‐CFC indicating occult CAD, treatment with 1C AADs appears not to increase mortality. A larger study would be required to confidently assess the safety of these drugs in this context.

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Section: Discussionsupporting

confidence: 84%

Class 1C antiarrhythmic drugs in atrial fibrillation and coronary artery disease

Pantlin

Bober

Bernard

et al. 2020

Cardiovasc electrophysiol

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“…18,51 It has also been used off-label in a small cohort of patients with PVC-induced cardiomyopathy, but without ischemic heart disease, resulting in a reduction in PVCs and improvement in ejection fraction with no evidence of proarrhythmia after a mean of 3.8 years of treatment. 52 Efficacy of Flecainide for the Treatment of AF…”

Section: Other Indications For Usementioning

confidence: 99%

Use of Flecainide for the Treatment of Atrial Fibrillation

Echt

Ruskin

2020

The American Journal of Cardiology

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Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with substantial morbidity and impairment of quality of life. Restoration and maintenance of normal sinus rhythm is a desirable goal for many patients with AF; however, this strategy is limited by the relatively small number of antiarrhythmic drugs (AADs) available for AF rhythm control. Although it is recommended in current medical guidelines as first-line therapy for patients without structural heart disease, the use of flecainide has been curtailed since the completion of the Cardiac Arrhythmia Suppression Trial. In clinical trials and real-world use, flecainide has proven to be more effective than other AADs for the acute termination of recent onset AF. Flecainide is also moderately effective and, with the exception of amiodarone, equivalent to other AADs for the chronic suppression of paroxysmal and persistent AF. In patients without structural heart disease, flecainide has been demonstrated to be safe and well tolerated relative to other AADs. Despite this favorable profile, flecainide is underutilized, likely due to a perceived risk of ventricular proarrhythmia, a concern that has not been borne out in patients without underlying structural heart disease. Guidelines for administration and use of flecainide are summarized in this review.

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“…For LBBB‐cardiomyopathy, CRT is the best validated form of treatment to date, although CSP also holds promise . For PVC‐induced cardiomyopathy, the dose of dyssynchrony can be ameliorated either with catheter ablation of PVCs or antiarrhythmic drug therapy …”

Section: Pathophysiology Of Pacing‐induced Cardiomyopathymentioning

confidence: 99%

Pacing induced cardiomyopathy

Merchant

Mittal

2019

Cardiovasc electrophysiol

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Pacing induced cardiomyopathy (PICM) is most commonly defined as a drop in left ventricle ejection fraction (LVEF) in the setting of chronic, high burden right ventricle (RV) pacing. Recent data suggest, however, that some individuals may experience the onset of heart failure symptoms more acutely after pacemaker implantation.Definitions of PICM which emphasize drop in LVEF may underestimate the incidence of deleterious effects from RV pacing. Treatment of PICM has primarily focused on upgrade to cardiac resynchronization therapy (CRT) when LVEF has dropped.However, emerging data suggest that conduction system pacing (CSP) may offer an opportunity to prevent PICM in the first place.cardiac resynchronization therapy, cardiomyopathy, conduction system pacing, device upgrade, dyssynchrony, his bundle pacing, left bundle branch block, pacemaker

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Class IC antiarrhythmic drugs for suspected premature ventricular contraction–induced cardiomyopathy

Abstract: In patients suspected of having PVC-CM, IC-AADs effectively suppressed PVCs, leading to LVEF recovery in the majority. No adverse events occurred in this small cohort.

Cited by 70 publications

References 26 publications

Class 1C antiarrhythmic drugs in atrial fibrillation and coronary artery disease

Class 1C antiarrhythmic drugs in atrial fibrillation and coronary artery disease

Use of Flecainide for the Treatment of Atrial Fibrillation

Pacing induced cardiomyopathy

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