This protocol covers catecholaminergic polymorphic ventricular tachycardia (CPVT) in patients presenting with arrhythmic syncope or documented bidirectional or polymorphic ventricular tachycardia, in the absence of aborted cardiac arrest. These findings indicate incomplete arrhythmic suppression and define the population requiring structured escalation of therapy.
Patients with CPVT who develop arrhythmic syncope or have documented bidirectional or polymorphic ventricular tachycardia — particularly when occurring while on beta-blocker therapy — represent a high-priority group. Persistent arrhythmic events at the highest tolerated beta-blocker dose are the defining feature that directs the treatment approach.
Management in this setting involves combination antiarrhythmic therapy: a non-selective beta-blocker maintained at the highest tolerated dose, together with the addition of a further antiarrhythmic agent. The complete regimen, specific agent selection, and any additional interventional considerations are set out in the full structured protocol.
DOI: 10.1093/eurheartj/ehac262
Data suggest that flecainide significantly reduces the VA burden in CPVT patients and should be considered in addition to beta-blockers when control of arrhythmias is incomplete.
Flecainide should be considered in patients with CPVT who experience recurrent syncope, polymorphic/bidirectional VT, or persistent exertional PVCs, while on beta-blockers at the highest tolerated dose.
ICD implantation should be considered in patients with CPVT who experience arrhythmogenic syncope and/or documented bidirectional/PVT while on highest tolerated beta-blocker dose and on flecainide.
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