Lal R, Chapman P D, Naccarrelli G V, Troup P J, Rinkenberger R L, Dougherty A H, Ruffy R
J Am Coll Cardiol. 1985 Oct;6(4):772-9. doi: 10.1016/s0735-1097(85)80481-2.
Thirty-eight patients with organic heart disease and history of sudden cardiac arrest or recurrent sustained ventricular tachycardia were treated with flecainide. Coronary artery disease was present in 33 patients. Previous antiarrhythmic therapy consisted of two to eight drugs (mean four). Fourteen patients were resuscitated from sudden cardiac death and 24 patients had chronic recurrent sustained ventricular tachycardia. Twenty-eight patients had electrophysiologic testing before and during flecainide treatment. Sustained ventricular tachycardia became noninducible in 5 patients, nonsustained in 5 patients and slowed in 13 patients (cycle length increased from 278 +/- 64 to 395 +/- 91 ms; p = 0.002). Three of the 14 patients with sudden cardiac death and 15 of the 24 patients with recurrent sustained ventricular tachycardia remained on long-term flecainide treatment. The mean left ventricular ejection fraction in 16 of these 18 patients was 37%. Nonlimiting side effects occurred in seven patients (18%). Proarrhythmic effects were seen in four patients (10%). At a mean follow-up time of 11 +/- 3 months, 15 patients (39%) had had no recurrence, including 5 who had inducible sustained ventricular tachycardia and 5 who did not on retesting during treatment. In the 18 patients who received long-term therapy, 3 late deaths occurred, 1 of which was of arrhythmic origin. These data suggest that flecainide is effective in about 40% of patients with severe refractory ventricular arrhythmias. Its value as a single drug in the treatment of sudden cardiac death remains to be defined.
38例患有器质性心脏病且有心脏骤停或复发性持续性室性心动过速病史的患者接受了氟卡尼治疗。33例患者存在冠状动脉疾病。既往抗心律失常治疗使用过2至8种药物（平均4种）。14例患者从心源性猝死中复苏，24例患者有慢性复发性持续性室性心动过速。28例患者在氟卡尼治疗前及治疗期间进行了电生理检查。5例患者持续性室性心动过速变为不能诱发，5例变为非持续性，13例减慢（心动周期长度从278±64毫秒增加到395±91毫秒；p = 0.002）。14例心源性猝死患者中的3例以及24例复发性持续性室性心动过速患者中的15例继续接受氟卡尼长期治疗。这18例患者中16例的平均左心室射血分数为37%。7例患者（18%）出现非限制性副作用。4例患者（10%）出现促心律失常作用。平均随访时间为11±3个月时，15例患者（39%）未复发，其中包括5例治疗期间再次检查时可诱发持续性室性心动过速的患者和5例不可诱发的患者。在接受长期治疗的18例患者中，发生3例晚期死亡，其中1例源于心律失常。这些数据表明，氟卡尼对约40%的严重难治性室性心律失常患者有效。其作为单一药物治疗心源性猝死的价值尚待确定。
