title: Use of flecainide in combination antiarrhythmic therapy in patients with arrhythmogenic right ventricular cardiomyopathy.
abstract: Antiarrhythmic therapy is commonly used for suppression of arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) in conjunction with implantable cardioverter-defibrillators and catheter ablation. The efficacy of combination flecainide and sotalol/metoprolol therapy for patients refractory to single agents and/or catheter ablation has not been well established.
  
  
  
  The purpose of this study was to describe our experience with the addition of flecainide in combination with sotalol/metoprolol for treatment of arrhythmias in patients with ARVC.
  
  
  
  We reviewed all patients within our genetic arrhythmia program with a definite diagnosis of ARVC (45 patients) and identified 8 patients treated with a combination of flecainide with sotalol/metoprolol after failure of single-agent therapy and/or catheter ablation. These patients were monitored with at least yearly clinic visits and device interrogations focused on the detection of major ventricular arrhythmias.
  
  
  
  Of the 8 patients reviewed, 6 demonstrated excellent arrhythmia control after initiation of combination therapy with flecainide and sotalol/metoprolol. These patients have been arrhythmia-free for an average of 35.5 months. Two patients have demonstrated recurrent arrhythmias despite combination therapy and have undergone repeat epicardial and endocardial ablation. Recurrence was noted to occur within 2 months of therapy. Patients were diverse with regard to the severity of disease as well as in the presence of genetic mutations.
  
  
  
  The addition of flecainide in combination with sotalol/metoprolol may be an effective antiarrhythmic strategy for the control of ventricular arrhythmias in patients with ARVC refractory to single-agent therapy and/or catheter ablation.
authors.affiliation: Division of Cardiovascular Medicine, University of California-San Francisco, San Francisco, California. Electronic address: Simon.Ermakov@ucsf.edu.
authors.forename: Simon
authors.initials: S
authors.lastname: Ermakov
authors.affiliation: Division of Cardiovascular Medicine, University of California-San Francisco, San Francisco, California.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
authors.affiliation: Division of Cardiovascular Medicine, University of California-San Francisco, San Francisco, California.
authors.forename: Yana
authors.initials: Y
authors.lastname: Svetlichnaya
authors.affiliation: Division of Cardiovascular Medicine, University of California-San Francisco, San Francisco, California.
authors.forename: Melvin M
authors.initials: MM
authors.lastname: Scheinman
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D016903:Drug Monitoring / Q000379:methods / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D005424:Flecainide / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D012008:Recurrence; D013015:Sotalol / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D008790:Metoprolol; D005424:Flecainide
keywords: Antiarrhythmic therapy; Arrhythmogenic right ventricular cardiomyopathy; Clinical electrophysiology; Combination therapy; Ventricular arrhythmia