Abstract：
BACKGROUND: To evaluate the clinical outcomes of oral mexiletine (oMXT) to treat ventricular tachyarrhythmias (VTAs) in the era of implantable cardioverter-defibrillator (ICD) technology.
METHODS: A systematic search was conducted using PubMed, Embase and Cochrane databases following the PRISMA guidelines to collect literature data reporting oMXT efficacy and safety outcomes in treating VTAs in ICD recipients.
RESULTS: Final analysis included four studies accounting for a total of 91 patients with recurrent VTAs treated with oMXT. Amiodarone therapy was initially attempted in most patients (91.2%), while catheter ablation was performed in one-third of patients. VTA recurrences were observed in 55/91 patients (60.4%) during oMXT treatment compared to 91/91 (100%) before treatment (P<0.001). Appropriate therapies occurred in 55/88 ICD patients (62.5%) during oMXT treatment compared to 80/88 (90.9%) before treatment (P<0.001). After oMXT introduction, there was a significant reduction of the individual burden of VTA episodes and appropriate ICD therapies per patient, showing Hedges\'g values of -1.103 (P=0.002) and -1.474 (P=0.008), respectively. Safety analysis showed a sample-weighted overall side-effect rate of 30%, while 21% of patients required drug reduction or discontinuation. Aggregated meta-regression analysis of the included studies and remote literature revealed a linear correlation between oMXT dosage and the overall side effects rate (r2 = 0.48; P=0.014).
CONCLUSIONS: Oral mexiletine provides an adjunctive treatment to manage VTAs and reduces appropriate therapies in ICD patients with moderate efficacy and acceptable safety profiles. These observations await confirmation through randomised clinical trials.
METHODS: A systematic search was conducted using PubMed, Embase and Cochrane databases following the PRISMA guidelines to collect literature data reporting oMXT efficacy and safety outcomes in treating VTAs in ICD recipients.
RESULTS: Final analysis included four studies accounting for a total of 91 patients with recurrent VTAs treated with oMXT. Amiodarone therapy was initially attempted in most patients (91.2%), while catheter ablation was performed in one-third of patients. VTA recurrences were observed in 55/91 patients (60.4%) during oMXT treatment compared to 91/91 (100%) before treatment (P<0.001). Appropriate therapies occurred in 55/88 ICD patients (62.5%) during oMXT treatment compared to 80/88 (90.9%) before treatment (P<0.001). After oMXT introduction, there was a significant reduction of the individual burden of VTA episodes and appropriate ICD therapies per patient, showing Hedges\'g values of -1.103 (P=0.002) and -1.474 (P=0.008), respectively. Safety analysis showed a sample-weighted overall side-effect rate of 30%, while 21% of patients required drug reduction or discontinuation. Aggregated meta-regression analysis of the included studies and remote literature revealed a linear correlation between oMXT dosage and the overall side effects rate (r2 = 0.48; P=0.014).
CONCLUSIONS: Oral mexiletine provides an adjunctive treatment to manage VTAs and reduces appropriate therapies in ICD patients with moderate efficacy and acceptable safety profiles. These observations await confirmation through randomised clinical trials.
摘要：
背景：评估在植入式心律转复除颤器（ICD）技术时代口服美西律（oMXT）治疗室性心律失常（VTA）的临床效果。
方法：使用Pubmed进行了系统搜索，遵循PRISMA指南的Embase和Cochrane数据库收集报告在ICD受者中治疗VTA的oMXT疗效和安全性结果的文献数据。
结果：最终分析包括4项研究，共91例复发性VTA患者接受oMXT治疗。大多数患者最初尝试胺碘酮治疗（91.2%），而三分之一的患者进行了导管消融。与治疗前的91/91(100%)相比,在oMXT治疗期间在55/91患者(60.4%)中观察到VTA复发(p<0.001)。与治疗前的80/88（90.9%）相比，oMXT治疗期间55/88ICD患者（62.5%）发生了适当的治疗（p<0.001）。在OMXT引入之后,每位患者的VTA发作和适当的ICD治疗的个人负担显着降低，显示对冲值-1.103(p=0.002)和-1.474(p=0.008)，分别。安全性分析表明，样本加权总副作用率为30%，而21%的患者需要减量或停药。纳入研究和远程文献的汇总荟萃回归分析显示，oMXT剂量与总副作用率之间存在线性相关（r2=0.48；p=0.014）。
结论：口服美西律提供了一种辅助治疗来管理VTA，并减少了ICD患者的适当治疗，具有中等疗效和可接受的安全性。这些观察结果等待随机临床试验的确认。
方法：使用Pubmed进行了系统搜索，遵循PRISMA指南的Embase和Cochrane数据库收集报告在ICD受者中治疗VTA的oMXT疗效和安全性结果的文献数据。
结果：最终分析包括4项研究，共91例复发性VTA患者接受oMXT治疗。大多数患者最初尝试胺碘酮治疗（91.2%），而三分之一的患者进行了导管消融。与治疗前的91/91(100%)相比,在oMXT治疗期间在55/91患者(60.4%)中观察到VTA复发(p<0.001)。与治疗前的80/88（90.9%）相比，oMXT治疗期间55/88ICD患者（62.5%）发生了适当的治疗（p<0.001）。在OMXT引入之后,每位患者的VTA发作和适当的ICD治疗的个人负担显着降低，显示对冲值-1.103(p=0.002)和-1.474(p=0.008)，分别。安全性分析表明，样本加权总副作用率为30%，而21%的患者需要减量或停药。纳入研究和远程文献的汇总荟萃回归分析显示，oMXT剂量与总副作用率之间存在线性相关（r2=0.48；p=0.014）。
结论：口服美西律提供了一种辅助治疗来管理VTA，并减少了ICD患者的适当治疗，具有中等疗效和可接受的安全性。这些观察结果等待随机临床试验的确认。
