Experience with electrophysiologically guided therapy of ventricular tachycardia with flecainide: summary of long-term follow-up.

In a heterogeneous group of 15 patients with clinical syncope or documented sustained ventricular tachycardia (VT), with induced sustained or nonsustained VT at programmed electrical stimulation, flecainide prevented tachycardia induction in 9 of 15 patients (60%) and improved responses in 2, for a 73% initial favorable response rate. Cycle length of induced rhythms increased an average of 141 ms after the drug. Antiarrhythmic response rate was higher in the absence of coronary artery disease. Ten of these patients were selected for a long-term drug trial. After a median follow-up of 13.5 months, 8 patients (53%) continue to receive flecainide, 6 (40%) successfully treated with flecainide alone and 1 each treated with concomitant therapy with amiodarone and a programmable antitachycardia pacemaker. Minor dosage adjustments were made during early outpatient therapy in 5 patients. Those continuing on therapy show a remarkable absence of side effects and stable drug concentrations. Therapy failed in 2 patients at 0.5 and 4 months, in 1 in association with progression of cardiomyopathy and in another with recurrence of sustained (slow) VT. Although our results have been favorable, preliminary reports from other laboratories have been mixed. Therefore, further experience is needed. In summary, flecainide appears promising in selected patients with VT using a carefully monitored approach including electrophysiologic induction studies.