High-dose flecainide with low-dose β-blocker therapy in catecholaminergic polymorphic ventricular tachycardia: A case report and review of the literature. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Steinfurt, Johannes; Dechant, Markus-Johann; Böckelmann, Doris; Zumhagen, Sven; Stiller, Brigitte; Schulze-Bahr, Eric; Bode, Christoph; Odening, Katja E.
• Is Part Of: Journal of cardiology cases. Volume 11:Issue 1(2015:Jan.)
• Page Start: 10
• Page End: 13
• Publication Date: 2015-01
• Subjects: Cardiology -- Periodicals; Cardiovascular Diseases -- Case Reports; Cardiovascular Diseases -- Periodicals; Cardiology -- Case Reports; Cardiology -- Periodicals; Cardiology; Electronic journals; Periodicals; 616.12
• DOI: 10.1016/j.jccase.2014.08.009
• Languages: English
• ISSNs: 1878-5409

Abstract

<abstract abstract-type="author" id="abs0005"> <title id="sect0005">Abstract</title> <sec> <title id="sect0010">Background</title> <p id="spar0005">Catecholaminergic polymorphic ventricular tachycardia (CPVT) is characterized by recurrent syncopes and sudden cardiac death triggered by sympathetic activation in young individuals without structural heart disease and a normal baseline electrocardiogram. There is reason to question whether the current expert consensus treatment recommendation, <italic>maximal</italic> tolerated β-blockade alone or in combination with low-dose flecainide, is the <italic>optimal</italic> antiarrhythmic treatment strategy in CPVT, as high doses of β-blockers may eventually lead to adverse side effects and β-blocker discontinuation. Indeed, β-blocker non-compliance accounts for around 5% of sudden cardiac deaths in CPVT patients.</p> </sec> <sec> <title id="sect0015">Case report</title> <p id="spar0010">Differing from the current recommendation, we present the first report of a CPVT patient successfully treated with high-dose flecainide and <italic>minimal</italic> β-blockade. This combination resulted in complete suppression of ventricular arrhythmias during exercise stress tests and Holter monitoring and was well tolerated without any side effects. We review the current literature on β-blocker non-compliance-related sudden cardiac death in CPVT, summarize the <italic>in vitro</italic> and <italic>in vivo</italic> data on flecainide therapy in CPVT, and discuss the rationale of our antiarrhythmic approach.</p> <p id="spar0015"><<bold>Learning objective:</bold> This case illustrates typical features of CPVT including the therapeutic management of a young CPVT patient with poor β-blocker tolerance at normal dosages. In this setting, high-dose flecainide combined with <italic>minimal</italic> β-blockade may (1) result in complete antiarrhythmic response and may (2) improve the antiarrhythmic drug-compliance thereby reducing the risk of non-compliance-related sudden cardiac death.></p> </sec> </abstract>