Division of Cardiology, West Vicenza General Hospitals, Arzignano, Italy.
Acta Cardiol. 2022 May;77(3):264-270. doi: 10.1080/00015385.2021.1926628. Epub 2021 May 19.
The pharmacological therapy of ventricular arrhythmias in patients with unsuccessful or not feasible catheter ablation and contraindication or inefficacy to amiodarone and beta-blockers, is controversial. The present study investigated the effectiveness and tolerability of mexiletine in patients with recurrent ventricular arrhythmias and ischaemic heart disease, when the conventional antiarrhythmic therapy failed.
We enrolled all consecutive patients with unsuccessful/not feasible catheter ablation and ineffective/contraindicated amiodarone or beta-blockers, which started the mexiletine treatment for refractory ventricular tachycardia (VT) or ventricular fibrillation (VF) between January 2010 and January 2020. The primary endpoint was the total number of VT/VF episodes after the beginning of mexiletine therapy. The 2 secondary endpoints were the overall number of therapies released by implantable cardioverter-defibrillators (ICDs) and the discontinuation of the pharmacological therapy. The events occurring during the mexiletine treatment period were compared with those observed in a matched duration interval before the initiation of therapy.
Thirty-four consecutive patients (27 males, 79.4%; mean age 74.0 ± 9.5 years) with ischaemic heart disease were finally analysed. The median of mexiletine treatment was 26.5 months (interquartile range: 18.75-38.25 months). After the mexiletine start, VT/VF episodes and ICD interventions significantly decreased (respectively: 74 vs 33 episodes, = 0.002; 116 vs 52 interventions, = 0.02) in comparison with a matched period without mexiletine. Six patients (13.9%) discontinued the treatment because of severe side effects.
The treatment period following the mexiletine start was associated with a significant reduction of ventricular arrhythmias. The rate of side effects requiring dosage reduction or interruption was not neglectable.
对于导管消融不成功或不可行且胺碘酮和β受体阻滞剂禁忌或无效的患者的室性心律失常的药物治疗存在争议。本研究调查了米贝地尔在常规抗心律失常治疗失败后患有复发性室性心律失常和缺血性心脏病的患者中的有效性和耐受性。
我们纳入了 2010 年 1 月至 2020 年 1 月期间因难治性室性心动过速（VT）或心室颤动（VF）而开始米贝地尔治疗且导管消融不成功/不可行且胺碘酮和β受体阻滞剂无效/禁忌的所有连续患者。主要终点是米贝地尔治疗开始后 VT/VF 发作的总数。两个次要终点是植入式心脏复律除颤器（ICD）释放的总治疗次数和药物治疗的终止。将米贝地尔治疗期间发生的事件与治疗开始前的匹配时间段观察到的事件进行比较。
最终分析了 34 例连续患者（27 名男性，79.4％；平均年龄 74.0±9.5 岁），均患有缺血性心脏病。米贝地尔治疗的中位数为 26.5 个月（四分位距：18.75-38.25 个月）。与没有米贝地尔的匹配时间段相比，米贝地尔开始后 VT/VF 发作和 ICD 干预明显减少（分别为：74 次 vs 33 次， = 0.002；116 次 vs 52 次干预， = 0.02）。有 6 名患者（13.9％）因严重副作用而停止治疗。
米贝地尔开始治疗后的治疗期与室性心律失常的显著减少相关。需要减少剂量或中断治疗的副作用发生率不容忽视。
