title: Flecainide therapy reduces exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia.
abstract: OBJECTIVE
  This study evaluated the efficacy and safety of flecainide in addition to conventional drug therapy in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT).
  
  
  BACKGROUND
  CPVT is an inherited arrhythmia syndrome caused by gene mutations that destabilize cardiac ryanodine receptor Ca(2+) release channels. Sudden cardiac death is incompletely prevented by conventional drug therapy with β-blockers with or without Ca(2+) channel blockers. The antiarrhythmic agent flecainide directly targets the molecular defect in CPVT by inhibiting premature Ca(2+) release and triggered beats in vitro.
  
  
  METHODS
  We collected data from every consecutive genotype-positive CPVT patient started on flecainide at 8 international centers before December 2009. The primary outcome measure was the reduction of ventricular arrhythmias during exercise testing.
  
  
  RESULTS
  Thirty-three patients received flecainide because of exercise-induced ventricular arrhythmias despite conventional (for different reasons, not always optimal) therapy (median age 25 years; range 7 to 68 years; 73% female). Exercise tests comparing flecainide in addition to conventional therapy with conventional therapy alone were available for 29 patients. Twenty-two patients (76%) had either partial (n = 8) or complete (n = 14) suppression of exercise-induced ventricular arrhythmias with flecainide (p < 0.001). No patient experienced worsening of exercise-induced ventricular arrhythmias. The median daily flecainide dose in responders was 150 mg (range 100 to 300 mg). During a median follow-up of 20 months (range 12 to 40 months), 1 patient experienced implantable cardioverter-defibrillator shocks for polymorphic ventricular arrhythmias, which were associated with a low serum flecainide level. In 1 patient, flecainide successfully suppressed exercise-induced ventricular arrhythmias for 29 years.
  
  
  CONCLUSIONS
  Flecainide reduced exercise-induced ventricular arrhythmias in patients with CPVT not controlled by conventional drug therapy.
authors: Department of Cardiology, Heart Failure Research Center, Academic Medical Center, Amsterdam, the Netherlands.
authors: Christian
authors: C
authors: van der Werf
authors: Prince J
authors: PJ
authors: Kannankeril
authors: Frederic
authors: F
authors: Sacher
authors: Andrew D
authors: AD
authors: Krahn
authors: Sami
authors: S
authors: Viskin
authors: Antoine
authors: A
authors: Leenhardt
authors: Wataru
authors: W
authors: Shimizu
authors: Naokata
authors: N
authors: Sumitomo
authors: Frank A
authors: FA
authors: Fish
authors: Zahurul A
authors: ZA
authors: Bhuiyan
authors: Albert R
authors: AR
authors: Willems
authors: Maurits J
authors: MJ
authors: van der Veen
authors: Hiroshi
authors: H
authors: Watanabe
authors: Julien
authors: J
authors: Laborderie
authors: Michel
authors: M
authors: Haïssaguerre
authors: Björn C
authors: BC
authors: Knollmann
authors: Arthur A M
authors: AA
authors: Wilde
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