Flecainide in Ventricular Arrhythmias: From Old Myths to New Perspectives
Abstract
:1. Introduction
2. Epidemiology of Ventricular Arrhythmia
3. Mechanisms and Clinical Evaluation of Ventricular Arrhythmia
3.1. Pathogenesis
3.2. Clinical Presentation and Electrocardiographic Morphology
4. Flecainide Pharmacology
4.1. Pharmacodynamics
4.2. Pharmacokinetics
4.3. Controlled Release Flecainide
5. Guidelines
5.1. Ventricular Tachycardias in Structurally Normal Hearts
5.2. CPVT
5.3. Long QT Syndrome Type 3
5.4. Andersen-Tawil Syndrome (ATS)–LQTS 7
6. Flecainide: Evidence Gap and Future Perspective
6.1. Ischaemic Heart Disease
6.2. Non-Ischemic Structural Heart Disease
7. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
AAD | Antiarrhythmic Drug |
ACC | American College of Cardiology |
AF | Atrial Fibrillation |
AHA | American Heart Association |
ARVC | Arrhythmogenic Right Ventricular Cardiomyopathy |
BBRT | Bundle Branch Reentry Tachycardia |
CAD | Coronary Artery Disease |
CMR | Cardiac Magnetic Resonance |
CPVT | Catecholaminergic Polymorphic Ventricular Tachycardia |
ESC | European Society of Cardiology |
ECG | Electrocardiogram |
HRS | Heart Rhythm Society |
IVA | Idiopathic Ventricular Arrhythmia |
LBBB | Left Bundle Branch Block |
LQTS | Long QT Syndrome |
LV | Left Ventricle |
LVOT | Left Ventricular Outflow Tract |
MI | Myocardial Infarction |
PCI | Percutaneous Coronary Intervention |
PVC | Premature Ventricular Complex |
RBBB | Right Bundle Branch Block |
RVOT | Right Ventricular Outflow Tract |
SCD | Sudden Cardiac Death |
VT | Ventricular Tachycardia |
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Origin of VT/PVC | Treatment Recommended | COR | LEO |
---|---|---|---|
RVOT | Primary Catheter Ablation preferred to Class IC | I | B |
LVOT/Aortic Cusp/Epicardial | Class IC first line | I | C |
Catheter Ablation after drug failure | IIA | B | |
Idiopathic Left VT | Catheter Ablation first line | I | B |
Class IC, beta blockers, verapamil alternative | I | C | |
Papillary muscle | Class IC, beta blockers, verapamil first line | I | C |
Catheter Ablation after drug failure | IIA | B | |
Mitral and Tricuspid anulus | Class IC, beta blockers, verapamil first line | I | C |
Catheter Ablation after drug failure | IIA | B | |
Children with RVOT/LVOT | Class IC alternative to beta blockers/verapamil | IIA | C |
Catheter Ablation after drug failure if >5 years | IIA | B | |
CPVT | Flecainide should be added to betablockers in case of recurrent syncope or bidirectional VT | IIA * I ** | C B-NR |
Flecainide should be added to betablockers to reduce ICD appropriate shocks | IIA | C | |
LQTS type 3 | Sodium channel blockers (flecainide, mexiletine, ranolazine) as add-on to shorten QTc > 500 ms | IIB | C |
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Lavalle, C.; Trivigno, S.; Vetta, G.; Magnocavallo, M.; Mariani, M.V.; Santini, L.; Forleo, G.B.; Grimaldi, M.; Badagliacca, R.; Lanata, L.; et al. Flecainide in Ventricular Arrhythmias: From Old Myths to New Perspectives. J. Clin. Med. 2021, 10, 3696. https://doi.org/10.3390/jcm10163696
Lavalle C, Trivigno S, Vetta G, Magnocavallo M, Mariani MV, Santini L, Forleo GB, Grimaldi M, Badagliacca R, Lanata L, et al. Flecainide in Ventricular Arrhythmias: From Old Myths to New Perspectives. Journal of Clinical Medicine. 2021; 10(16):3696. https://doi.org/10.3390/jcm10163696
Chicago/Turabian StyleLavalle, Carlo, Sara Trivigno, Giampaolo Vetta, Michele Magnocavallo, Marco Valerio Mariani, Luca Santini, Giovanni Battista Forleo, Massimo Grimaldi, Roberto Badagliacca, Luigi Lanata, and et al. 2021. "Flecainide in Ventricular Arrhythmias: From Old Myths to New Perspectives" Journal of Clinical Medicine 10, no. 16: 3696. https://doi.org/10.3390/jcm10163696