Treatment of CPVT with Arrhythmic Syncope or Documented Bidirectional Ventricular Tachycardia

Clinical Scenario

This protocol applies to patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) who have experienced arrhythmic syncope or have documented bidirectional or polymorphic ventricular tachycardia, and who have not had an aborted cardiac arrest.

Treatment Approach

Management involves a targeted procedure directed at cardiac sympathetic innervation. The complete regimen — including candidacy criteria, sequencing, and clinical decision points — is contained in the full protocol.

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References

DOI: 10.1093/eurheartj/ehac262

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.

LCSD should be considered in patients with diagnosis of CPVT when the combination of beta-blockers and flecainide at therapeutic dosage are either not effective, not tolerated, or contraindicated.

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