Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare inherited cardiomyopathy affecting young patients. The prognosis is conditioned by ventricular arrhythmia and optimal treatment remain unknown.

The aim of this study is to evaluate effectiveness and safety of flecainide to prevent sudden cardiac death in ARVC.

Sixty-one patients with proven ARVC treated with flecainide between 2002 and 2015 were retrospectively included. Rhythm control was checked by 24hours electrocardiography monitoring and programmed ventricular stimulation before and after treatment initiation. Catheter ablation was performed, in addition to pharmacological treatment, in case of sustained ventricular arrhythmia. Primary endpoint was the occurrence of spontaneous sustained ventricular arrhythmia or appropriated therapy by implantable cardioverter-defibrillator.

Mean age was 46.6±13.9 years old. Mean follow-up duration was 50±37 months. The ventricular arrhythmia rate of occurrence was 4.3% per year. There was no death during follow-up. Mean dose of flecainide was 200mg. Catheter ablation was performed in 32 patients (52.5%): 16 before flecainide administration and 16 after positive programmed ventricular stimulation under treatment. Mean premature ventricular contraction burden after treatment decreased from 4687 to 1596 PVCs (P=0.02). Programmed ventricular stimulation negativation was achieved in 40 patients (65.4%). Negativation of programmed ventricular stimulation significantly decreased the rate of ventricular arrhythmia occurrence (P<0.01) (Table 1, Fig. 1).

Flecainide induced a significant decrease of ventricular arrhythmia in ARVC, in association to catheter ablation. Treatment coverage can be evaluated by programmed ventricular stimulation.