Generic Portal

TY - JOUR

T1 - Effectiveness and safety of mexiletine in patients at risk for (recurrent) ventricular arrhythmias

T2 - a systematic review

AU - van der Ree, Martijn H

AU - van Dussen, Laura

AU - Rosenberg, Noa

AU - Stolwijk, Nina

AU - van den Berg, Sibren

AU - van der Wel, Vincent

AU - Jacobs, Bart A W

AU - Wilde, Arthur A M

AU - Hollak, Carla E M

AU - Postema, Pieter G

N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2022/11/22

Y1 - 2022/11/22

N2 - AIMS: 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.METHODS AND RESULTS: 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).CONCLUSIONS: 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.

AB - AIMS: 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.METHODS AND RESULTS: 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).CONCLUSIONS: 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.

KW - Humans

KW - Infant, Newborn

KW - Infant

KW - Child, Preschool

KW - Child

KW - Adolescent

KW - Young Adult

KW - Adult

KW - Middle Aged

KW - Aged

KW - Aged, 80 and over

KW - Mexiletine/adverse effects

KW - Arrhythmias, Cardiac/chemically induced

KW - Ventricular Fibrillation

KW - Electrocardiography

KW - Heart Ventricles

U2 - 10.1093/europace/euac087

DO - 10.1093/europace/euac087

M3 - Article

C2 - 36036670

VL - 24

SP - 1809

EP - 1823

JO - EP Europace

JF - EP Europace

SN - 1099-5129

IS - 11

ER -