Flecainide Monotherapy for Catecholaminergic Polymorphic Ventricular Tachycardia: Perspectives and Limitations.

CPVT is a severe inherited arrhythmogenic disease. The standard, therapeutic approach with beta-blockers fails to protect affected, subjects from arrhythmic recurrencies in approximately 30 % of cases. The use of flecainide in association with beta-blockers was empirically tested in few cases and in larger cohorts thereafter, demonstrating a favorable effect. The paper by Padfield et al. in this issue of the Journal is aimed at testing the possibility of using flecainide as a monotherapy. Clearly this approach may represent a sharp departure form the current management scheme for CPVT. In this commentary the current knowledge, limitations and the future perspectives for the use of this approach are revised.