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Efficacy of mexiletine in the treatment of patients with recurrent ventricular arrhythmias in long-term follow-up
Session:
Posters (Sessão 6 - Écran 2) - Arrítmias 6 - Arrítmias Ventriculares 2
Speaker:
Gonçalo José Lopes Da Cunha
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Gonçalo Lopes da Cunha; Sérgio Maltês; Miguel Mendes; Pedro Adragão
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Introduction</span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Arial",sans-serif">Several studies report a significant reduction in arrhythmic burden in patients with recurrent ventricular arrythmias treated with mexiletine during a midterm follow-up (1 to 3 years). However, the number and distribution of arrhythmic events along time is not constant, possibly leading to under or overestimation of the effect of anti-arrhythmic drugs in shorter follow-ups.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Arial",sans-serif">This study sought to evaluate the efficacy of mexiletine in suppression of ventricular arrhythmias in long term follow-up.</span></span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods</span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Arial",sans-serif">This was a single centre, retrospective study enrolling patients who were prescribed mexiletine for treatment of recurrent ventricular arrhythmias. In order to evaluate efficacy, patients were only included if they were on mexiletine for more than 12 months. Follow-up was done through electronic records and telephonic questioning when appropriate. The events occurring during the mexiletine treatment period were compared with those observed in a matched duration interval before the initiation of therapy. We collected all the episodes of electric storm and isolated defibrillator shocks (i.e. defibrillator shocks administered outside the electric storm episodes).</span></span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results</span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Arial",sans-serif">Overall, 22 patients were included (86% male, mean age at initiation of mexiletine of 68±7 years). Of these 64% had previous myocardial infarction and 68% had at least one ventricular tachycardia (VT) ablation. All patients had an implanted defibrillator. Mean mexiletine dosage was 419±157mg. In 5 (20%) patients mexiletine was withdrawn (2 after successful VT ablation, 1 due to heart transplantation, 1 due to pro-arrythmia and 1 due to heart failure). During a median follow up of 53 (28 to 97) months, there were 9 episodes of electric storm (ES) and 39 episodes of isolated electrical cardioversions (EC).There was no significant decrease in the total number of ES or EC after the beginning of mexiletine therapy (p=0.204 and p=0.144, respectively). </span></span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Conclusion</span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Arial",sans-serif">We found that there was no significant decrease in the number of ventricular arrhythmias during a long term follow up. In these challenging subset of patients, medical therapy has very limited efficacy, leading to the need for further developments in VT ablation technique.</span></span></span></p>
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