Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy associated with a high risk of ventricular arrhythmia (VA). Current guidelines recommend beta-blockers as first line medical therapy and if ineffective, treatment by sotalol or amiodarone.

To describe our experience as a tertiary centre for ARVC on flecainide effectiveness and tolerance in addition to beta-blockers to prevent ventricular arrhythmia in ARVC.

We included one hundred ARVC patients treated with flecainide and beta-blocker diagnosed between May 1999 and November 2017.

Ventricular events including sustained ventricular tachycardia (VT), ventricular fibrillation (VF) and ICD therapy were collected retrospectively in patient's medical records.

Besides, a 24hours Holter monitoring and a programmed ventricular stimulation (PVS) before and after introduction of flecainide were performed.

Tolerance of flecainide was good with 9% discontinuation (6 for VA occurrence, 2 for side effect, 1 for atrial fibrillation). No Brugada-induced ECG pattern on flecainide was reported.

PVC burden on 24hours Holter monitoring (n=46 patients) was significantly decreased under treatment (2370; IQR1572–3400 versus 415; IQR97–730, P<0.0001).

Proportion of positive PVS was significantly decreased (n=32 patients) with 94% having positive PVS before treatment compared to 37.5% on flecainide (P<0.001) (Fig. 1).

During a median follow-up of 47 (IQR24–74) months, 23 patients had sustained VA (all monomorphic VT) on treatment (5% per patient–year). No sudden death occurred.

This study suggests that flecainide and beta-blockers association is complementary to ICD and catheter ablation, and is safe to treat ARVC patients with persistent symptomatic VA.