Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(10), 1220–1226. https://doi.org/10.1002/clc.24090 Dr. Dejan Kojić et al.
Points
- Beta-blockers and dihydropyridine calcium channel blockers are commonly used as first-line treatments for idiopathic premature ventricular complexes (PVCs), but their efficacy is limited.
- This retrospective study compared the effectiveness and safety of flecainide, propafenone, and sotalol, which are antiarrhythmic drugs, in treating symptomatic idiopathic PVCs.
- Flecainide demonstrated the highest efficacy, with a lower PVC burden of over 99% in 56% of patients, compared to 11% for propafenone and 21% for sotalol.
- A reduction in % PVC burden of at least 80% was achieved in 64% of patients on flecainide, compared to 30% on propafenone and 33% on sotalol.
- The study concluded that flecainide was the most effective antiarrhythmic drug in achieving significant reduction or complete/near-complete elimination of PVC burden in patients with symptomatic idiopathic PVCs.
Summary
This retrospective study aimed to compare the effectiveness and safety of flecainide, propafenone, and sotalol in treating symptomatic idiopathic premature ventricular complexes (PVCs). The study analyzed 104 consecutive patients with 130 medication episodes of frequent idiopathic PVCs treated with these antiarrhythmic drugs (AADs). The primary outcome was the complete or near-complete reduction of PVCs after the medication episode, while the secondary outcome was a significant reduction in PVC burden.
The results showed that the complete or near-complete reduction of PVC burden occurred in 31% of treated patients, and a significant reduction was observed in 43% of patients. Flecainide demonstrated the highest efficacy, with a reduction of PVC burden of over 99% achieved in 56% of patients. In comparison, propafenone and sotalol had lower efficacy rates, with reductions of over 99% in only 11% and 21% of patients, respectively. A reduction in % PVC burden of at least 80% was achieved in 64% of patients on flecainide, compared to 30% on propafenone and 33% on sotalol.
In conclusion, the study found that the efficacy of AADs of class Ic and III in treating idiopathic PVCs was modest. Flecainide was the most effective AAD in achieving a complete or near-complete reduction of PVC burden, as well as a significant reduction, compared to propafenone and sotalol. These findings provide valuable insights into the treatment options for symptomatic idiopathic PVCs and can guide clinicians in selecting the most appropriate AAD for their patients.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24090
References Kojić, D., Radunović, A., Bukumirić, Z., Rajsic, S., Sušić, M., Marić, M., Žugić, V., Jurčević, R., & Tomović, M. (2023). Idiopathic premature ventricular complexes treatment: Comparison of flecainide, propafenone, and sotalol. Clinical Cardiology, 46(10), 1220–1226. https://doi.org/10.1002/clc.24090
