Ermakov Simon, Hoffmayer Kurt S, Gerstenfeld Edward P, Scheinman Melvin M
Cardiovascular Division, Department of Medicine, University of California San Francisco, San Francisco, California.
Pacing Clin Electrophysiol. 2014 Jan;37(1):90-4. doi: 10.1111/pace.12250. Epub 2013 Sep 17.
Drug therapy for patients with right ventricular (RV) cardiomyopathy refractory to single-drug therapy and ablation has not been well defined.
We reviewed our entire RV cardiomyopathy database (31 patients) and found four patients presenting with ventricular arrhythmias of RV origin refractory to single-drug therapy. These patients underwent complete evaluation for arrhythmogenic right ventricular cardiomyopathy (ARVC).
Following the revised 2010 task force criteria, of these four patients, three were diagnosed with ARVC, and one with cardiac sarcoidosis. These patients proved to be refractory to drug monotherapy and either failed or deemed to not be candidates for endocardial ablation. Their arrhythmias were ultimately controlled with combinations of sotalol, flecainide, and mexiletine.
In our experience, combination drug therapy is an effective treatment strategy for patients with ventricular tachycardia refractory to monotherapy and, in some cases, ablation. In addition, flecainide appears to be safe and effective for those with RV cardiomyopathy without significant left ventricular dysfunction.
对于单药治疗和消融治疗无效的右心室心肌病患者，药物治疗尚未明确。
我们回顾了整个右心室心肌病数据库（31例患者），发现4例起源于右心室的室性心律失常患者对单药治疗无效。这些患者接受了致心律失常性右心室心肌病（ARVC）的全面评估。
根据2010年修订的工作组标准，这4例患者中，3例被诊断为ARVC，1例被诊断为心脏结节病。这些患者被证明对单药治疗无效，并且要么消融失败，要么被认为不适合进行心内膜消融。他们的心律失常最终通过索他洛尔、氟卡尼和美西律联合治疗得到控制。
根据我们的经验，联合药物治疗是治疗对单药治疗无效以及在某些情况下对消融治疗无效的室性心动过速患者的有效治疗策略。此外，氟卡尼对于没有明显左心室功能障碍的右心室心肌病患者似乎是安全有效的。
