Dataset Information

Comparing the Efficacy of Carvedilol and Flecainide on the Treatment of Idiopathic Premature Ventricular Complexes from Ventricular Outflow Tract: A Multicenter, Randomized, Open-Label Pilot Study.

ABSTRACT: The mechanism of premature ventricular complexes (PVC) occurring in the ventricular outflow tract (OT) is related to an intracellular calcium overload and delayed afterdepolarizations that lead to triggered activity. The guidelines recommend using beta-blockers and flecainide for idiopathic PVCs, but they also acknowledge the limited evidence supporting this recommendation. We conducted a multicenter, randomized, open-label pilot study comparing the effect of carvedilol and flecainide on OT PVC, which are widely used to treat this arrhythmia. Patients with a 24 h Holter recording a PVC burden ≥ 5%, which showed positive R waves in leads II, III, and aVF, and without structural heart disease were enrolled. They were randomly assigned to the carvedilol or flecainide group, and the maximum tolerated dose was administered for 12 weeks. A total of 103 participants completed the protocol: 51 with carvedilol and 52 with flecainide. After 12 weeks of treatment, the mean PVC burden significantly decreased in both groups: 20.3 ± 11.5 to 14.6 ± 10.8% with carvedilol (p < 0.0001) and 17.1 ± 9.9 to 6.6 ± 9.9% with flecainide (p < 0.0001). Both carvedilol and flecainide effectively suppressed OT PVCs in patients without structural heart disease, with flecainide showing a superior efficacy compared to carvedilol.

SUBMITTER: Hwang J

PROVIDER: S-EPMC10144596 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Comparing the Efficacy of Carvedilol and Flecainide on the Treatment of Idiopathic Premature Ventricular Complexes from Ventricular Outflow Tract: A Multicenter, Randomized, Open-Label Pilot Study.

Hwang Jongmin J Oh Yong-Seog YS Park Hyoung-Seob HS Choi Jong-Il JI Lee Young Soo YS Choi Eue-Keun EK Shin Dong-Gu DG On Young Keun YK Kim Tae-Hoon TH Park Hyung Wook HW Cho Min Soo MS Bae Myung Hwan MH Han Seongwook S

Journal of clinical medicine 20230415 8

The mechanism of premature ventricular complexes (PVC) occurring in the ventricular outflow tract (OT) is related to an intracellular calcium overload and delayed afterdepolarizations that lead to triggered activity. The guidelines recommend using beta-blockers and flecainide for idiopathic PVCs, but they also acknowledge the limited evidence supporting this recommendation. We conducted a multicenter, randomized, open-label pilot study comparing the effect of carvedilol and flecainide on OT PVC, ...[more]

PMID: 37109225

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Project description:BackgroundThe ventricular premature complexes (PVCs) originating from the superior right ventricular outflow tract (RVOT) have high success rates by catheter ablation. It may not be the same when the origin is in the inferior RVOT.ObjectiveTo identify electrocardiographic (ECG) characteristics that predict the site for successful ablation of PVCs originating in the inferior RVOT.MethodsOf 309 consecutive patients with symptomatic PVCs despite medical therapy, 124 had PVCs originating from the RVOT, and 107 RVOT cases without structural heart disease and no bundle branch block in sinus rhythm were enrolled in the study. Among them, 74 have a superior RVOT origin, and 33 have an inferior RVOT origin.ResultsThe proportion with multiple morphologies of PVC was significantly higher in the inferior RVOT group than in the superior RVOT group (24.24 vs. 6.76%, P = 0.011). The QRS duration of PVCs with an inferior RVOT origin was more expansive than PVCs with a superior RVOT origin (162.42 ± 19.69 ms vs. 140.90 ± 11.30 ms; P < 0.001). Furthermore, the QRS wave in V1 in patients in the inferior RVOT group was more likely to have a negative delta wave at the onset of the QRS (27.27 vs. 1.39%, P < 0.001). We found that the areas under the receiver-operating characteristic curve (AUCs) for PVC diagnosis with an inferior RVOT origin ranged from 0.812 to 0.841 depending on ECG features, with the highest AUC for the QRS duration of PVCs and the amplitude of R waves in lead II. These ECG indices had good predictability for judging the origin of PVCs in the RVOT; the best threshold for the QRS duration of PVCs was 145 ms, and the best thresholds for the amplitude of R waves in leads II, III, and aVF were 1.35, 1.35, and 1.15 mV, respectively.ConclusionWhen evaluating a patient with PVCs, the source is likely to be the inferior RVOT if the ECG presentation conforms to the morphological characteristics of the RVOT, meanwhile, the QRS wave is relatively broad and polymorphic, and the main waves in limb leads (II, III, and aVF) are upward with low amplitude.

Dataset Information

Comparing the Efficacy of Carvedilol and Flecainide on the Treatment of Idiopathic Premature Ventricular Complexes from Ventricular Outflow Tract: A Multicenter, Randomized, Open-Label Pilot Study.

Publications

Comparing the Efficacy of Carvedilol and Flecainide on the Treatment of Idiopathic Premature Ventricular Complexes from Ventricular Outflow Tract: A Multicenter, Randomized, Open-Label Pilot Study.

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