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Article

Comparing the Efficacy of Carvedilol and Flecainide on the Treatment of Idiopathic Premature Ventricular Complexes from Ventricular Outflow Tract: A Multicenter, Randomized, Open-Label Pilot Study

by
Jongmin Hwang
1,†,
Yong-Seog Oh
2,†,
Hyoung-Seob Park
1,
Jong-Il Choi
3,
Young Soo Lee
4,
Eue-Keun Choi
5,
Dong-Gu Shin
6,
Young Keun On
7,
Tae-Hoon Kim
8,
Hyung Wook Park
9,
Min Soo Cho
10,
Myung Hwan Bae
11 and
Seongwook Han
1,*
1
Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea
2
Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
3
Arrhythmia Center, Korea University Medical Center Anam Hospital, Seoul 02841, Republic of Korea
4
Department of Cardiology, Catholic University of Daegu, Daegu 42472, Republic of Korea
5
Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
6
Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea
7
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
8
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
9
Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
10
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
11
Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
 
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*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2023, 12(8), 2887; https://doi.org/10.3390/jcm12082887
Submission received: 27 March 2023 / Revised: 10 April 2023 / Accepted: 14 April 2023 / Published: 15 April 2023
(This article belongs to the Section Cardiology)
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Abstract

The mechanism of premature ventricular complexes (PVC) occurring in the ventricular outflow tract (OT) is related to an intracellular calcium overload and delayed afterdepolarizations that lead to triggered activity. The guidelines recommend using beta-blockers and flecainide for idiopathic PVCs, but they also acknowledge the limited evidence supporting this recommendation. We conducted a multicenter, randomized, open-label pilot study comparing the effect of carvedilol and flecainide on OT PVC, which are widely used to treat this arrhythmia. Patients with a 24 h Holter recording a PVC burden ≥ 5%, which showed positive R waves in leads II, III, and aVF, and without structural heart disease were enrolled. They were randomly assigned to the carvedilol or flecainide group, and the maximum tolerated dose was administered for 12 weeks. A total of 103 participants completed the protocol: 51 with carvedilol and 52 with flecainide. After 12 weeks of treatment, the mean PVC burden significantly decreased in both groups: 20.3 ± 11.5 to 14.6 ± 10.8% with carvedilol (p < 0.0001) and 17.1 ± 9.9 to 6.6 ± 9.9% with flecainide (p < 0.0001). Both carvedilol and flecainide effectively suppressed OT PVCs in patients without structural heart disease, with flecainide showing a superior efficacy compared to carvedilol.
Keywords: ventricular premature complexes; carvedilol; carvedilol; anti-arrhythmia agents ventricular premature complexes; carvedilol; carvedilol; anti-arrhythmia agents

Share and Cite

MDPI and ACS Style

Hwang, J.; Oh, Y.-S.; Park, H.-S.; Choi, J.-I.; Lee, Y.S.; Choi, E.-K.; Shin, D.-G.; On, Y.K.; Kim, T.-H.; Park, H.W.; et al. Comparing the Efficacy of Carvedilol and Flecainide on the Treatment of Idiopathic Premature Ventricular Complexes from Ventricular Outflow Tract: A Multicenter, Randomized, Open-Label Pilot Study. J. Clin. Med. 2023, 12, 2887. https://doi.org/10.3390/jcm12082887

AMA Style

Hwang J, Oh Y-S, Park H-S, Choi J-I, Lee YS, Choi E-K, Shin D-G, On YK, Kim T-H, Park HW, et al. Comparing the Efficacy of Carvedilol and Flecainide on the Treatment of Idiopathic Premature Ventricular Complexes from Ventricular Outflow Tract: A Multicenter, Randomized, Open-Label Pilot Study. Journal of Clinical Medicine. 2023; 12(8):2887. https://doi.org/10.3390/jcm12082887

Chicago/Turabian Style

Hwang, Jongmin, Yong-Seog Oh, Hyoung-Seob Park, Jong-Il Choi, Young Soo Lee, Eue-Keun Choi, Dong-Gu Shin, Young Keun On, Tae-Hoon Kim, Hyung Wook Park, and et al. 2023. "Comparing the Efficacy of Carvedilol and Flecainide on the Treatment of Idiopathic Premature Ventricular Complexes from Ventricular Outflow Tract: A Multicenter, Randomized, Open-Label Pilot Study" Journal of Clinical Medicine 12, no. 8: 2887. https://doi.org/10.3390/jcm12082887

APA Style

Hwang, J., Oh, Y.-S., Park, H.-S., Choi, J.-I., Lee, Y. S., Choi, E.-K., Shin, D.-G., On, Y. K., Kim, T.-H., Park, H. W., Cho, M. S., Bae, M. H., & Han, S. (2023). Comparing the Efficacy of Carvedilol and Flecainide on the Treatment of Idiopathic Premature Ventricular Complexes from Ventricular Outflow Tract: A Multicenter, Randomized, Open-Label Pilot Study. Journal of Clinical Medicine, 12(8), 2887. https://doi.org/10.3390/jcm12082887

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