Therapeutic approach for patients with catecholaminergic polymorphic ventricular tachycardia: state of the art and future developments

被引:132
作者
van der Werf, Christian [1 ]
Zwinderman, Aeilko H. [2 ]
Wilde, Arthur A. M. [1 ]
机构
[1] Univ Amsterdam, Acad Med Ctr, Heart Failure Res Ctr, Dept Cardiol, NL-1105 AZ Amsterdam, Netherlands
[2] Univ Amsterdam, Acad Med Ctr, Dept Clin Epidemiol & Biostat, NL-1105 AZ Amsterdam, Netherlands
来源
EUROPACE | 2012年 / 14卷 / 02期
关键词
Catecholaminergic polymorphic ventricular tachycardia; Syncope; Aborted cardiac arrest; Sudden cardiac death; Treatment; Therapy; Adrenergic beta-antagonists; Calcium channel blockers; Flecainide; Sympathectomy; SUDDEN CARDIAC DEATH; IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS; EXERCISE-INDUCED ARRHYTHMIAS; RYANODINE RECEPTOR GENE; CA2+ RELEASE; SYMPATHETIC DENERVATION; FOLLOW-UP; RYR2; MUTATIONS; FLECAINIDE; CHANNEL;
D O I
10.1093/europace/eur277
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmia syndrome characterized by bidirectional or polymorphic ventricular arrhythmias under conditions of increased sympathetic activity in young patients with structurally normal hearts. Patients with CPVT are at high risk of developing life-threatening ventricular arrhythmias when untreated. A wide variety of arrhythmic event rates on conventional therapy, with beta-blockers as the cornerstone, has been reported. Here, we systematically review all available studies describing the efficacy of beta-blocker therapy for prevention of arrhythmic events in CPVT. Because of heterogeneity between the studies, a random-effects meta-analysis model was used to assess the efficacy of beta-blocker therapy in preventing any arrhythmic event [syncope, aborted cardiac arrest (ACA), and sudden cardiac death (SCD)], near-fatal arrhythmic events (ACA and SCD), and fatal arrhythmic events. Eleven studies including 403 patients, of whom 354 (88%) had a beta-blocker prescribed, were identified. Mean follow-up ranged from 20 months to 8 years. Estimated 8-year arrhythmic, near-fatal, and fatal event rates were 37.2% [95% confidence interval (CI): 16.6-57.7], 15.3% (95% CI: 7.4-23.3), and 6.4% (95% CI: 3.2-9.6), respectively. In addition, we review the recent developments in alternate chronic treatment options for CPVT patients, including calcium channel blockers, flecainide, left cardiac sympathetic denervation, and implantable cardioverter defibrillators. A new treatment strategy is proposed, including a stepwise addition of the alternate treatment options to beta-blockers in patients who do not respond sufficiently to this first-line therapy. Finally, future developments in chronic treatment options and acute treatment options of ventricular arrhythmias are discussed.
引用
收藏
页码:175 / 183
页数:9
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