Abstract：
The aim of the study was to systematically review evidence on the effectiveness and safety of oral mexiletine administered in monotherapy or in combination with other antiarrhythmic drugs for recurrent ventricular arrhythmia (ventricular tachycardia/ventricular fibrillation, VT/VF) in adult patients with structural heart disease (SHD) and implantable cardioverter defibrillators (ICDs). We systematically searched MEDLINE, Embase, and CENTRAL databases from inception to 27 August 2021 for prospective and retrospective studies investigating mexiletine in the target population. The main outcome was the reduction of ICD therapy. The main safety outcome was the presence of any serious adverse events (SAEs) leading to mexiletine discontinuation. Study quality was assessed using the Cochrane risk of bias tool or the Newcastle-Ottawa scale. Four studies comprising 86 mexiletine recipients were included in the review. We also obtained individual data of 50 patients from two studies. Ischaemic cardiomyopathy (ICM) was present in 86% of patients. The quality of included studies was moderate/low. A narrative review was undertaken as studies varied widely in terms of study population and treatment. Across studies, mexiletine treatment (with or without amiodarone) seemed to consistently reduce the number of ICD therapies especially in a population where catheter ablation (CA) was unsuccessful or contraindicated. In ICM patients deemed eligible for CA, mexiletine seemed to be inferior to CA. Mexiletine was discontinued in 14% of cases, mainly for gastrointestinal or neurological SAE. Mexiletine seems to be an option for the long-term treatment of recurrent VT/VF in adult patients with SHD, especially ICM, and ICD in whom CA was unsuccessful or not suitable.
摘要：
该研究的目的是系统地审查单药或与其他抗心律失常药物联合使用口服美西律治疗复发性室性心律失常（室性心动过速/室颤，VT/VF）在患有结构性心脏病（SHD）和植入式心脏复律除颤器（ICD）的成年患者中。我们系统地搜索了MEDLINE,Embase,和CENTRAL数据库从开始到2021年8月27日，用于调查目标人群中美西律的前瞻性和回顾性研究。主要结果是减少了ICD治疗。主要安全性结果是存在导致美西律停药的任何严重不良事件（SAE）。使用Cochrane偏倚风险工具或纽卡斯尔-渥太华量表评估研究质量。包括86名美西律接受者的四项研究被纳入审查。我们还从两项研究中获得了50名患者的个体数据。86％的患者存在缺血性心肌病（ICM）。纳入研究的质量为中/低。由于研究在研究人群和治疗方面差异很大，因此进行了叙述性审查。在整个研究中，美西律治疗(加胺碘酮或不加胺碘酮)似乎可持续减少ICD治疗的数量,尤其是在导管消融(CA)不成功或禁忌的人群中.在ICM患者被认为有资格获得CA，美西律似乎不如CA。14％的病例停用了美西律，主要用于胃肠道或神经系统SAE。美西律似乎是SHD成年患者复发性VT/VF的长期治疗选择，尤其是ICM,以及CA不成功或不适合的ICD。
