Flecainide acetate prevents recurrence of symptomatic paroxysmal supraventricular tachycardia. The Flecainide Supraventricular Tachycardia Study Group.

Abstract

Oral flecainide acetate was administered to 34 patients with documented symptomatic paroxysmal supraventricular tachycardia (PSVT) with a double-blind, placebo-controlled, 8-week crossover trial design. PSVT was defined as a regular tachycardia of at least 120 beats/min without evidence of atrioventricular dissociation. The study required considerable patient cooperation. Patients first entered a 4-week qualifying phase followed by a 3-week, open label, flecainide dose-ranging phase. They were then randomized in a blind fashion to receive either placebo or tolerated flecainide dose for an 8-week treatment period and then crossed over after four symptomatic documented episodes of PSVT or at the end of the treatment period. By all efficacy parameters analyzed, flecainide was superior to placebo. Flecainide was associated with an actuarial 79% freedom from symptomatic PSVT events compared with only 15% on placebo at 60 days (p less than 0.001). Of the 34 patients, 29 had recurrence of symptomatic PSVT at least once during the placebo phase; only eight patients had a recurrence during the flecainide phase (p less than 0.001). The median time to the first symptomatic PSVT event was 11 days in the placebo group and greater than 55 days in the flecainide group (p less than 0.001). Likewise, the interval between attacks was a median of 12 days on placebo compared with more than 55 days on flecainide (p less than 0.001). Finally, the flecainide slowed symptomatic PSVT heart rates to 143 +/- 12 beats/min from 178 +/- 12 on placebo (p less than 0.02) in the seven patients who had events in the placebo and flecainide treatment phases.(ABSTRACT TRUNCATED AT 250 WORDS)

Event‐Recorder Monitoring in the Diagnosis of Atrial Fibrillation in Symptomatic Patients: Subanalysis of the SOPAT Trial

“…This was also reported by others using transtelephonic event recording in a small group of patients with paroxysmal SVT or AF 12 . Antiarrhythmic therapy with Q+V and sotalol significantly lowered the heart rate during both symptomatic and asymptomatic AF, compared with placebo, which was also shown for other antiarrhythmics 13 . Based on these findings, reduction of the heart rate seems to be an important factor for a quality of life improvement in these patients.…”

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary

“…In patients with WPW syndrome, syncope should be taken seriously but is not necessarily associated with increased risk of SCD. 25 The rate of AVRT is faster when AVRT is induced during exercise, 26 yet the rate alone does not explain symptoms of near-syncope. Elderly patients with AVNRT are more prone to syncope or near-syncope than are younger patients, but the tachycardia rate is generally slower in the elderly.…”

Diagnosis and management of supraventricular tachycardia

“…In one small placebo controlled study 79% of patients in the flecainide group and 15% in the placebo group did not experience symptoms, though the follow-up period was only eight weeks. 28 Proarrhythmia, including ventricular tachycardia, has been reported in 6% of patients. 29 Agents to slow atrioventricular node conduction are often co-administered, as flecainide may predispose to atrial flutter with 1:1 atrioventricular conduction.…”