MEXILETINE AS A STAND-ALONE ANTIARRHYTHMIC AGENT FOR ELECTRICAL STORM AND RECURRENT VENTRICULAR ARRHYTHMIAS

Abstract

Objectives: In developing countries like India, patients with ventricular arrhythmias who were treated with antiarrhythmic
drugs, in whom catheter ablation or implantable cardioverter-defibrillators (ICDs) were ineffective or contraindicated, are still
obscured. Thus we aimed to evaluate the efficacy of mexiletine in patients with ventricular tachyarrhythmias/electrical storm,
in whom standard treatment failed to prevent ventricular tachyarrhythmias.
Methods: We performed a prospective, unicentric, observational study in patients with ventricular tachyarrhythmias treated
with mexiletine in our institute from January 2019 to March 2021. The study population included all patients presented with
recurrent ventricular tachyarrhythmias, with or without ICD.
Results: Among the arrhythmic patients included in the study 20(80%) had monomorphic ventricual tachycardia (VT),
3(12%) had polymorphic VT and 2(8%) patients had ventricular fibrillation (VF). Patients were followed for 12 months,
which showed only one patient had an episode of VT after initiating mexiletine (p<0.001). Total number of shocks and ATPs
were significantly reduced compared to prior initiation of mexiletine (p<0.01 & p<0.001, respectively). Patients treated with
mexiletine and both (mexiletine+amiodarone), did not have significant difference when compared to their long term efficacy.
Survival analysis showed that the patients treated with mexiletine had increased survival rate compared to patients who were
treated with other antiarrhythmic drugs.
Conclusions: The study indicates that treatment with mexiletine may be effective and safe in patients with ICD and frequent
ventricular arrhythmias and ICD shocks, regardless of the aetiology of heart disease.