Class 1C Antiarrhythmics for Premature Ventricular Complex Suppression in Nonischemic Cardiomyopathy with Implantable Cardioverter-Defibrillators (JCEP May 2024)-Article: Class 1C Antiarrhythmics for Premature Ventricular Complex Suppression in Nonischemic Cardiomyopathy with Implantable Cardioverter-Defibrillators

Article: Class 1C Antiarrhythmics for Premature Ventricular Complex Suppression in Nonischemic Cardiomyopathy with Implantable Cardioverter-Defibrillators

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The study focused on the use of Class 1C antiarrhythmic drugs (AADs) in patients with nonischemic cardiomyopathy (NICM) and implantable cardioverter-defibrillators (ICDs) to suppress premature ventricular complexes (PVCs). The research demonstrated that the use of flecainide and propafenone effectively suppressed PVCs, leading to a decrease in PVC burden, an increase in left ventricular ejection fraction (LVEF), and an improvement in biventricular pacing percentage. The study included 34 patients, most of whom had failed previous AADs or catheter ablation. The results showed a significant decrease in PVC burden, an increase in LVEF, and an improvement in biventricular pacing percentage with Class 1C AAD treatment. The safety outcomes indicated a reduction in sustained ventricular tachycardia and admissions for heart failure exacerbations compared to the year before treatment initiation. The study concluded that Class 1C AADs were well-tolerated in this patient population, with no increase in adverse events. The findings suggest that these drugs may be safe and effective for PVC suppression in patients with NICM and ICDs, potentially challenging existing guideline restrictions. Larger studies are recommended to confirm the safety and efficacy of this approach.

Keywords

Class 1C antiarrhythmic drugs

nonischemic cardiomyopathy

implantable cardioverter-defibrillators

premature ventricular complexes

flecainide

propafenone

left ventricular ejection fraction

biventricular pacing percentage

sustained ventricular tachycardia

heart failure exacerbations