Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Heart Rhythm. 2018 Feb;15(2):159-163. doi: 10.1016/j.hrthm.2017.12.018.
Class IC antiarrhythmic drugs (IC-AADs) can effectively suppress premature ventricular contractions (PVCs). However, IC-AADs increase mortality in patients with PVCs and left ventricular dysfunction after myocardial infarction. Whether IC-AADs can be safely used to treat premature ventricular contraction-induced cardiomyopathy (PVC-CM) remains to be established.
The purpose of this study was to determine the safety and efficacy of IC-AADs in patients suspected of having PVC-CM.
The electronic medical records at the Hospital of the University of Pennsylvania were screened to identify all patients suspected of having PVC-CM treated with flecainide or propafenone. Clinical, electrocardiographic, and imaging studies were reviewed.
Twenty patients suspected of having PVC-CM were treated with IC-AADs. Patients had undergone an average of 1.3 ± 0.2 previous unsuccessful ablations. Six had an implantable or wearable defibrillator. With IC-AAD treatment, mean PVC burden decreased from 36.2% ± 3.5% to 10.0% ± 2.4% (P <.001). Mean left ventricular ejection fraction (LVEF) increased from 37.4% ± 2.0% to 49.0% ± 1.9% (P <.001). Seven patients with myocardial delayed enhancement on cardiac magnetic resonance imaging (all <5% of the total myocardium) experienced similar improvement in LVEF (from 36.8% ± 4.3% before IC-AAD to 51.7% ± 3.7% afterward; P <.01). Over an average 3.8 ± 0.9 treatment-years, no sustained ventricular arrhythmias or sudden cardiac deaths occurred.
In patients suspected of having PVC-CM, IC-AADs effectively suppressed PVCs, leading to LVEF recovery in the majority. No adverse events occurred in this small cohort.
IC 类抗心律失常药物（IC-AADs）可有效抑制室性期前收缩（PVCs）。然而，IC-AADs 会增加心肌梗死后 PVC 伴左室功能障碍患者的死亡率。IC-AADs 是否可安全用于治疗室性期前收缩诱导性心肌病（PVC-CM）仍有待确定。
本研究旨在确定怀疑患有 PVC-CM 的患者使用 IC-AAD 的安全性和疗效。
筛选宾夕法尼亚大学医院的电子病历，以确定所有接受氟卡尼或普罗帕酮治疗的疑似 PVC-CM 患者。回顾临床、心电图和影像学研究。
20 例疑似 PVC-CM 的患者接受了 IC-AAD 治疗。患者平均接受了 1.3 ± 0.2 次先前不成功的消融术。6 例患者植入或佩戴了除颤器。使用 IC-AAD 治疗后，平均 PVC 负荷从 36.2%±3.5%降至 10.0%±2.4%（P<.001）。平均左心室射血分数（LVEF）从 37.4%±2.0%增加至 49.0%±1.9%（P<.001）。7 例心脏磁共振成像（CMR）显示心肌延迟强化（均<5%的总心肌）的患者 LVEF 也有类似改善（从 IC-AAD 治疗前的 36.8%±4.3%增加至治疗后的 51.7%±3.7%；P<.01）。在平均 3.8 ± 0.9 年的治疗期间，无持续性室性心律失常或心源性猝死发生。
在疑似患有 PVC-CM 的患者中，IC-AADs 可有效抑制 PVCs，导致大多数患者 LVEF 恢复。该小队列未发生不良事件。
