Combination Drug Therapy for Patients with Intractable Ventricular Tachycardia Associated with Right Ventricular Cardiomyopathy

Authors

  • SIMON ERMAKOV M.D.,

    Corresponding author
    1. Cardiovascular Division, Department of Medicine, University of California San Francisco, San Francisco, California
    • Address for reprints: Simon Ermakov, M.D., Cardiovascular Division, Department of Medicine, University of California San Francisco, 500 Parnassus Ave, MUE 434 San Francisco, CA 94143-1354. Fax: 415-476-3505; e-mail: Simon.Ermakov@ucsf.edu

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  • KURT S. HOFFMAYER M.D.,

    1. Cardiovascular Division, Department of Medicine, University of California San Francisco, San Francisco, California
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  • EDWARD P. GERSTENFELD M.D.,

    1. Cardiovascular Division, Department of Medicine, University of California San Francisco, San Francisco, California
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  • MELVIN M. SCHEINMAN M.D.

    1. Cardiovascular Division, Department of Medicine, University of California San Francisco, San Francisco, California
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  • Financial disclosures: Dr. Melvin Scheinman is working with Medtronics, St. Jude, Biotronic, and Boston Scientific. He has received consultant fees from Janssen Inc. and fees for lectures. No other authors have any financial disclosures.

Abstract

Background

Drug therapy for patients with right ventricular (RV) cardiomyopathy refractory to single-drug therapy and ablation has not been well defined.

Methods

We reviewed our entire RV cardiomyopathy database (31 patients) and found four patients presenting with ventricular arrhythmias of RV origin refractory to single-drug therapy. These patients underwent complete evaluation for arrhythmogenic right ventricular cardiomyopathy (ARVC).

Results

Following the revised 2010 task force criteria, of these four patients, three were diagnosed with ARVC, and one with cardiac sarcoidosis. These patients proved to be refractory to drug monotherapy and either failed or deemed to not be candidates for endocardial ablation. Their arrhythmias were ultimately controlled with combinations of sotalol, flecainide, and mexiletine.

Conclusions

In our experience, combination drug therapy is an effective treatment strategy for patients with ventricular tachycardia refractory to monotherapy and, in some cases, ablation. In addition, flecainide appears to be safe and effective for those with RV cardiomyopathy without significant left ventricular dysfunction.

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