BACKGROUND Class IC antiarrhythmic drugs (IC-AADs) can effectively suppress premature ventricular contractions (PVCs). However, IC-AADs increase mortality in patients with PVCs and left ventricular dysfunction after myocardial infarction. Whether IC-AADs can be safely used to treat premature ventricular contraction-induced cardiomyopathy (PVC-CM) remains to be established. OBJECTIVE The purpose of this study was to determine the safety and efficacy of IC-AADs in patients suspected of having PVC-CM. METHODS The electronic medical records at the Hospital of the University of Pennsylvania were screened to identify all patients suspected of having PVC-CM treated with flecainide or propafenone. Clinical, electro-cardiographic, and imaging studies were reviewed. RESULTS Twenty patients suspected of having PVC-CM were treated with IC-AADs. Patients had undergone an average of 1.3 +/- 0.2 previous unsuccessful ablations. Six had an implantable or wearable defibrillator. With IC-AAD treatment, mean PVC burden decreased from 36.2% +/- 63.5% to 10.0% +/- 62.4% (P <. 001). Mean left ventricular ejection fraction (LVEF) increased from 37.4% 6 2.0% to 49.0% +/- 1.9% (P < .001). Seven patients with myocardial delayed enhancement on cardiac magnetic resonance imaging (all <5% of the total myocardium) experienced similar improvement in LVEF (from 36.8% +/- 4.3% before IC-AAD to 51.7% +/- 3.7% afterward; P < .01). Over an average 3.8 +/- 0.9 treatment-years, no sustained ventricular arrhythmias or sudden cardiac deaths occurred. CONCLUSION 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.
Class IC antiarrhythmic drugs for suspected premature ventricular contraction-induced cardiomyopathy
Muser D;
2018-01-01
Abstract
BACKGROUND Class IC antiarrhythmic drugs (IC-AADs) can effectively suppress premature ventricular contractions (PVCs). However, IC-AADs increase mortality in patients with PVCs and left ventricular dysfunction after myocardial infarction. Whether IC-AADs can be safely used to treat premature ventricular contraction-induced cardiomyopathy (PVC-CM) remains to be established. OBJECTIVE The purpose of this study was to determine the safety and efficacy of IC-AADs in patients suspected of having PVC-CM. METHODS The electronic medical records at the Hospital of the University of Pennsylvania were screened to identify all patients suspected of having PVC-CM treated with flecainide or propafenone. Clinical, electro-cardiographic, and imaging studies were reviewed. RESULTS Twenty patients suspected of having PVC-CM were treated with IC-AADs. Patients had undergone an average of 1.3 +/- 0.2 previous unsuccessful ablations. Six had an implantable or wearable defibrillator. With IC-AAD treatment, mean PVC burden decreased from 36.2% +/- 63.5% to 10.0% +/- 62.4% (P <. 001). Mean left ventricular ejection fraction (LVEF) increased from 37.4% 6 2.0% to 49.0% +/- 1.9% (P < .001). Seven patients with myocardial delayed enhancement on cardiac magnetic resonance imaging (all <5% of the total myocardium) experienced similar improvement in LVEF (from 36.8% +/- 4.3% before IC-AAD to 51.7% +/- 3.7% afterward; P < .01). Over an average 3.8 +/- 0.9 treatment-years, no sustained ventricular arrhythmias or sudden cardiac deaths occurred. CONCLUSION 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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
