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Systematic review/meta-analysis

Mexiletine for recurrent ventricular tachycardia in adult patients with structural heart disease and implantable cardioverter-defibrillator – an EHRA systematic review (August 2022)

Mexiletine is a class Ib antiarrhythmic drug (AAD) seldom used to suppress ventricular arrhythmia. Clinical guidelines indicate its applicability as a long-term therapy option in type 3 long-QT syndrome however they do not formulate any recommendation for patients with structural heart disease (SHD), defined as ischemic (ICM) or non-ischaemic cardiomyopathy (NICM). The aim of this study was to systematically review available evidence on the effectiveness and safety of oral mexiletine administered in monotherapy or in combination with other AADs for treatment of recurrent ventricular arrhythmia in adult patients with SHD and an implantable cardioverter-defibrillator (ICD). 

Four studies, mostly retrospective and without a control group, comprising 86 mexiletine recipients were included in this systematic review. Included studies varied widely in terms of study population and details of antiarrhythmic treatment. Mexiletine, either in monotherapy or co-administered with amiodarone, seemed to consistently reduce the number of ICD therapies, especially in a population where catheter ablation (CA) was unsuccessful or contraindicated. In ICM patients deemed eligible for CA, mexiletine seemed to be inferior to CA. Mexiletine was discontinued mainly for gastro-intestinal or neurological SAE. 

The publication is available here

Effectiveness and safety of a single freeze strategy of cryoballoon ablation of atrial fibrillation: an EHRA systematic review and meta-analysis (July 2021)

Cryoballoon ablation of atrial fibrillation is among the most effective treatments of the rhythm control strategy. While effective and reproducible, some technical aspects of the procedure itself are still a matter of debate. The aim of the present review and meta-analysis was to assess if an empirical second cryoapplication per pulmonary vein, the so called ‘bonus freeze’, is associated with better clinical outcomes than a single cryoapplication (‘single freeze’) strategy.

The results of this meta-analysis support the single cryoapplication (‘single freeze’) technique. There was no significant difference between both strategies in terms of arrhythmia recurrence in one year follow-up. There were more complications associated with the ‘double freeze’ strategy with a strong trend for higher risk of persistent phrenic nerve palsy. Presented conclusions were based on three randomised controlled trials and 10 observational studies of moderate/good quality which compared both strategies in a head-to-head manner.

The publication is available here

Mobile health applications for managing atrial fibrillation for healthcare professionals and patients: an EHRA systematic review (August 2020)

A plethora of mobile health applications (m-health apps) to support healthcare are available for both patients and healthcare professionals (HCPs) but content and quality vary considerably and few have undergone formal assessment. The aim of this paper was to systematically review the literature on m-health apps for managing atrial fibrillation (AF) that examine the impact on knowledge of AF, patient and HCP behaviour, patients’ quality-of-life, and user engagement.

Mobile health apps demonstrate improvements in patient knowledge, behaviour, and quality of life. Studies formally evaluating the impact of m-health on HCP behaviour are scarce and larger-scale studies with representative patient cohorts, appropriate comparators, and longer-term assessment of the impact of m-health apps are warranted.

The publication is available here.