Therapeutic Inefficacy and Proarrhythmic Nature of Metoprolol Succinate and Carvedilol Therapy in Patients With Idiopathic, Frequent, Monomorphic Premature Ventricular Contractions
Küçük Resim Yok
Tarih
2022
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Lippincott Williams & Wilkins
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Background: Antiarrhythmic drugs remain the first-line therapy for treatment of idiopathic ventricular arrhythmias. Study Question: The aim of this study was to assess the therapeutic efficacy of extended-release metoprolol succinate (MetS) and carvedilol for idiopathic, frequent, monomorphic premature ventricular contractions (PVCs). Study Design: Study population consisted of 114 consecutive patients: 71 received MetS and 43 received carvedilol. Measures and Outcomes: All patients underwent 24-hour Holter monitoring at baseline and during drug therapy. PVC-burden response to drug therapy was categorized as good (>= 80% reduction), poor (either <80% reduction or <= 50% increase), and proarrhythmic responses (>50% increase) based on change in PVC burden compared with baseline. Results: Most common presenting symptom was palpitations (65.8%), followed by coincidental discovery (29%). The mean MetS and carvedilol dosages were 65.57 +/- 30.67 mg/d and 23.66 +/- 4.26 mg/d, respectively. Good, poor, and proarrhythmic responses were observed in 11.3% and 16.3%, 63.4% and 67.4%, and 25.3% and 16.3% of patients treated with MetS and carvedilol, respectively. In patients with relatively high (>= 16%) PVC burden, the sum of poor/proarrhythmic response was observed in 95.5% and 86.4% of patients treated with MetS and carvedilol, respectively. Proarrhythmic response was observed in 21.9% of the patients, particularly in the presence of relatively lower (<= 10%) baseline PVC burden. Patients with good response during beta-blocker therapy had higher baseline daily average intrinsic total heart beats compared with patients with poor/proarrhythmic response combined (96,437 +/- 26,488 vs. 86,635 +/- 15,028, P = 0.047, respectively). Side effects and intolerance were observed in 5.6% and 18.6% of patients treated with MetS and carvedilol, respectively. Conclusions: MetS and carvedilol for idiopathic, frequent, monomorphic PVCs are frequently inefficient. Therapeutic efficacy decreases further in patients with relatively high (>= 16%) PVC burden. Relatively higher baseline daily intrinsic total heart beats may be used to predict good response before beta-blocker therapy.
Açıklama
Anahtar Kelimeler
premature ventricular contraction, idiopathic ventricular arrhythmia, antiarrhythmic drugs, metoprolol succinate, carvedilol, proarrhythmia, Outflow Tract, Tachycardia, Suppression, Management
Kaynak
American Journal of Therapeutics
WoS Q Değeri
Q2
Scopus Q Değeri
Q2
Cilt
29
Sayı
1
