Propafenone in combination antiarrhythmic therapy for patients with catecholaminergic polymorphic ventricular tachycardia

Summary. Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited channelopathy characterized by bidirectional and/or polymorphic ventricular tachycardia triggered by physical or emotional stress. CPVT is associated with a high mortality rate if left untreated. Although beta-blockers are the cornerstone of pharmacologic management for catecholaminergic polymorphic ventricular tachycardia, their efficacy as monotherapy is often limited. This limitation highlights the need to investigate combination antiarrhythmic therapies that may more effectively reduce the risk of arrhythmogenic events and sudden cardiac death. Objective . To compare the efficacy and safety of beta-blocker monotherapy versus combination therapy (beta-blocker plus propafenone) in patients with catecholaminergic polymorphic ventricular tachycardia. Materials and Methods . The study included 68 patients diagnosed with catecholaminergic polymorphic ventricular tachycardia during childhood. Efficacy criteria for the therapy included the absence of ventricular and supraventricular arrhythmias and the absence of arrhythmogenic events during treatment. Results . Combined antiarrhythmic therapy with a beta-blocker and the class IC antiarrhythmic agent propafenone was significantly more effective in preventing stress-induced cardiac rhythm disturbances (p=0.00002) and arrhythmogenic events (p=0.02) compared to beta-blocker monotherapy. Conclusions . These results indicate that combination therapy with a beta-blocker and propafenone is more effective over beta-blocker monotherapy in patients with catecholaminergic polymorphic ventricular tachycardia. Further research is warranted to confirm these findings and to assess the potential inclusion of propafenone in future international clinical guidelines for catecholaminergic polymorphic ventricular tachycardia management.