Carvedilol significantly reduced the risk of inappropriate ICD shocks compared with metoprolol (HR 0.66; 95% CI 0.48-0.90; P=0.009), with no difference in recurrent arrhythmias or mortality.
Meta-Analysis (n=7,777)
Does carvedilol reduce all-cause mortality, recurrent ventricular arrhythmias, and inappropriate ICD shocks compared to metoprolol in patients with ventricular arrhythmias or ICDs?
Carvedilol is associated with a significantly lower risk of inappropriate ICD shocks and anti-tachycardia pacing compared to metoprolol in patients with ICDs or ventricular arrhythmias.
Hazard Ratio: 0.66 (95% CI 0.48–0.9)
p-value: p=0.009
Background Ventricular arrhythmias (VA) are major causes of morbidity and mortality in patients with cardiovascular disease. Implantable cardioverter-defibrillators (ICDs) are commonly used to prevent sudden cardiac death. However, patients with ICDs frequently experience recurrent arrhythmias and inappropriate shocks, which impact quality of life. Beta-blockers, specifically carvedilol and metoprolol, are commonly prescribed in this context. This meta-analysis aims to compare the impact of both medications in this patient population. Methods Comprehensive literature search was conducted to identify relevant studies comparing carvedilol to metoprolol in patients with VA or ICDs. Study outcomes included all-cause mortality, recurrent VA, and inappropriate ICD shocks. Effect estimates are presented as hazard ratios (HR) with 95% confidence intervals (CI). Results Five independent study populations, reported across six publications, including 7,777 patients (5,138 on carvedilol, 2,639 on metoprolol) were analyzed. Carvedilol was associated with a significantly lower risk of inappropriate ICD shocks (HR = 0.66, 95% CI: 0.48–0.90, P = 0.009) and inappropriate anti-tachycardia pacing (HR = 0.67, 95% CI: 0.49–0.91, P = 0.01) compared with metoprolol. There were no significant differences between the two beta-blockers in recurrent ventricular tachyarrhythmias or all-cause mortality. Conclusion Carvedilol may provide additional benefit over metoprolol in reducing inappropriate ICD therapies and anti-tachycardia pacing, while no significant differences were found in recurrent ventricular arrhythmias or all-cause mortality. These findings support consideration of carvedilol in patients with ICDs, but further research is warranted to guide optimal beta-blocker selection.
Ali et al. (Tue,) conducted a meta-analysis in Ventricular arrhythmias or implantable cardioverter-defibrillators (ICDs) (n=7,777). Carvedilol vs. Metoprolol was evaluated on Inappropriate ICD shocks (HR 0.66, 95% CI 0.48-0.90, p=0.009). Carvedilol significantly reduced the risk of inappropriate ICD shocks compared with metoprolol (HR 0.66; 95% CI 0.48-0.90; P=0.009), with no difference in recurrent arrhythmias or mortality.