Key result
Higher doses of beta-blockers (IDE-BB ≥ 55 mg/m2/day) increased the frequency of effective antitachycardia pacing compared to no beta-blockers (92% vs 75%, P<0.001).
Why the study?
Does beta-blocker therapy improve antitachycardia pacing effectiveness and reduce shocks in ICD patients with left ventricular dysfunction?
Observational (n=282)
Does beta-blocker therapy improve antitachycardia pacing effectiveness and reduce shocks in ICD patients with left ventricular dysfunction?
Higher doses of beta-blockers are associated with increased effectiveness of antitachycardia pacing and a reduced incidence of shocks in ICD patients with left ventricular dysfunction.
May support beta-blocker titration in ICD patients; hypothesis-generating and requires RCT confirmation before practice change.
AIMS: To determine, in a non-selected population of 282 implantable cardioverter-defibrillator (ICD) patients with left ventricular dysfunction, the influence of the dose of beta-blockers on antitachycardia pacing (ATP) effectiveness and on the incidence of shock due to monomorphic ventricular tachycardias (VT). METHODS AND RESULTS: We followed 282 ICD patients along 26 +/- 19 months. Antitachycardia pacing and shock programming were standardized. We determined the indexed dose equivalent of beta-blockers (IDE-BB), using metoprolol as a reference, at each VT presentation. The median of IDE-BB was 55 mg/m(2)/day. We analysed 846 VT occurred in 100 patients. The ATP success rate was 84%. Upon classification of the events into three groups (IDE-BB = 0, IDE-BB < 55, and IDE-BB > or = 55), the frequency of effective ATP increased with the IDE-BB: 75 vs. 83 vs. 92% (P < 0.001). According to logistic regression, IDE-BB remained as an independent predictor of effective ATP (P < 0.001) and VT-related shock (P = 0.001). Both the mean ATP effectiveness per patient (67 vs. 80 vs. 91%, P = 0.007) and the mean survival time free of VT-related shock (583 vs. 847 vs. 1158 days, P = 0.019, log-rank test) increased linearly with the dose of beta-blockers. CONCLUSION: Beta-blockers increase the effectiveness of ATP through a dose-dependent effect. As a result, they reduce the incidence of shocks due to VT.
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Jiménez‐Candil et al. (2010) conducted an observational in Left ventricular dysfunction with implantable cardioverter-defibrillator (n=282). Beta-blockers vs. No beta-blockers (IDE-BB = 0) was evaluated on Antitachycardia pacing (ATP) effectiveness (p=<0.001). Higher doses of beta-blockers (IDE-BB ≥ 55 mg/m2/day) increased the frequency of effective antitachycardia pacing compared to no beta-blockers (92% vs 75%, P<0.001).
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