关键词: Mexiletine Systematic review Ventricular arrhythmias

Mesh : Humans Infant, Newborn Infant Child, Preschool Child Adolescent Young Adult Adult Middle Aged Aged Aged, 80 and over Mexiletine / adverse effects Arrhythmias, Cardiac / chemically induced Ventricular Fibrillation Electrocardiography Heart Ventricles

来  源:   DOI:10.1093/europace/euac087

Abstract:
While mexiletine has been used for over 40 years for prevention of (recurrent) ventricular arrhythmias and for myotonia, patient access has recently been critically endangered. Here we aim to demonstrate the effectiveness and safety of mexiletine in the treatment of patients with (recurrent) ventricular arrhythmias, emphasizing the absolute necessity of its accessibility.
Studies were included in this systematic review (PROSPERO, CRD42020213434) if the efficacy or safety of mexiletine in any dose was evaluated in patients at risk for (recurrent) ventricular arrhythmias with or without comparison with alternative treatments (e.g. placebo). A systematic search was performed in Ovid MEDLINE, Embase, and in the clinical trial registry databases ClinicalTrials.gov and ICTRP. Risk of bias were assessed and tailored to the different study designs. Large heterogeneity in study designs and outcome measures prompted a narrative synthesis approach. In total, 221 studies were included reporting on 8970 patients treated with mexiletine. Age ranged from 0 to 88 years. A decrease in ventricular arrhythmias of >50% was observed in 72% of the studies for pre-mature ventricular complexes, 64% for ventricular tachycardia, and 33% for ventricular fibrillation. Electrocardiographic effects of mexiletine were small; only in a subset of patients with primary arrhythmia syndromes, a relative (desired) QTc decrease was reproducibly observed. As for adverse events, gastrointestinal complaints were most frequently observed (33% of the patients).
In this systematic review, we present all the currently available knowledge of mexiletine in patients at risk for (recurrent) ventricular arrhythmias and show that mexiletine is both effective and safe.
摘要:
虽然美西律已用于预防(复发性)室性心律失常和肌强直超过40年,患者通路最近受到严重威胁。在这里,我们旨在证明美西律治疗(复发性)室性心律失常患者的有效性和安全性。强调其无障碍的绝对必要性。
本系统综述包括研究(PROSPERO,CRD42020213434),如果在有或没有与替代疗法(例如安慰剂)比较的(复发性)室性心律失常风险的患者中评估了任何剂量的美西律的疗效或安全性。在OvidMEDLINE中进行了系统搜索,Embase,以及临床试验注册数据库ClinicalTrials.gov和ICTRP。对偏倚风险进行了评估,并针对不同的研究设计进行了调整。研究设计和结果测量的巨大异质性促使人们采用叙事综合方法。总的来说,221项研究报告了使用美西律治疗的8970例患者。年龄从0到88岁不等。在72%的早熟心室复合体研究中观察到室性心律失常减少>50%,64%为室性心动过速,和33%的心室纤颤。美西律的心电图效果较小;仅在原发性心律失常综合征患者的一部分中,可再现地观察到相对(期望的)QTc降低。至于不良事件,胃肠道主诉最常见(33%的患者).
在这篇系统综述中,我们介绍了目前所有可用于(复发性)室性心律失常风险患者的美西律知识,并表明美西律既有效又安全.
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