Background

Due to suspected pro-arrhythmic effects and increased mortality associated with class-IC antiarrhythmic drugs (AADs) in previous trials, AAD therapy in structural heart disease (SHD) is mainly restricted to amiodarone. In the presence of diagnostic and therapeutic advancements in cardiovascular medicine, it remains unclear if previous studies adequately reflect contemporary patients. In clinical practice, class-IC-AADs are occasionally used in individual cases, particularly in patients with an implantable cardioverter defibrillator (ICD).

Methods

This study retrospectively investigated outcome in ICD-carriers with SHD in whom class-IC-AADs were used as an individualized therapy due to failure, side effects, or unacceptable risk of alternative therapeutic options.

Results

Fifty patients from four tertiary centers were included (median age 48.5 years; 52% female). The most common underlying SHD were dilated (42%) or ischemic cardiomyopathy (26%) (median LVEF = 45%). Indications for AAD were sustained ventricular arrhythmias (VA) (58%), symptomatic premature ventricular contractions (26%), or atrial arrhythmias (16%). Median follow-up was 27.8 months. Freedom from sustained VA was 72%, and freedom from ICD therapy was 80%. In 19 patients (38%), AAD therapy was terminated. The most common reason was insufficient efficacy (n = 8). Pro-arrhythmia was suspected in three patients. Five patients died during follow-up (10.0%), two of cardiovascular cause (4.0%).

Conclusion

In a multicenter cohort of ICD-carriers with SHD, class-IC-AADs were associated with a low rate of pro-arrhythmic effects or cardiovascular mortality. The majority of patients remained free from sustained VA during a follow-up of > 2 years. Further efforts should be made to evaluate the safety of class-IC-AADs in SHD patients receiving contemporary cardiovascular therapy.

Graphical abstract

中文翻译：

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IC类抗心律失常药物在结构性心脏病和植入式心脏复律除颤器患者中的使用

背景

由于在之前的试验中怀疑与 IC 类抗心律失常药物 (AAD) 相关的促心律失常作用和死亡率增加，结构性心脏病 (SHD) 的 AAD 治疗主要限于胺碘酮。鉴于心血管医学诊断和治疗方面的进步，目前尚不清楚先前的研究是否充分反映了当代患者的情况。在临床实践中，IC 类 AAD 偶尔用于个别病例，特别是植入式心脏复律除颤器 (ICD) 的患者。

方法

本研究回顾性调查了患有 SHD 的 ICD 携带者的结果，其中由于失败、副作用或替代治疗选择的不可接受的风险，IC-AAD 类被用作个体化治疗。

结果

来自四个三级中心的 50 名患者被纳入研究（中位年龄 48.5 岁；52% 为女性）。最常见的潜在 SHD 是扩张型心肌病 (42%) 或缺血性心肌病 (26%)（中位 LVEF = 45%）。 AAD 的适应症是持续性室性心律失常 (VA) (58%)、有症状的室性早搏 (26%) 或房性心律失常 (16%)。中位随访时间为 27.8 个月。免于持续 VA 的比例为 72%，免于 ICD 治疗的比例为 80%。 19 名患者 (38%) 终止了 AAD 治疗。最常见的原因是疗效不足（n  = 8）。三名患者怀疑有促心律失常。 5 名患者在随访期间死亡（10.0%），其中 2 名患者死于心血管原因（4.0%）。

结论

在患有 SHD 的 ICD 携带者的多中心队列中，IC-AAD 与较低的促心律失常效应或心血管死亡率相关。在超过 2 年的随访期间，大多数患者没有出现持续性 VA。应进一步努力评估 IC-AAD 类药物在接受当代心血管治疗的 SHD 患者中的安全性。

图形概要