Propranolol combined with IV amiodarone reduced the incidence of ventricular arrhythmic events compared to metoprolol (IRR 0.375; 95% CI 0.207-0.678; p=0.001) in ICD patients with electrical storm.
RCT (n=60)
Does propranolol combined with IV amiodarone reduce ventricular arrhythmic events compared to metoprolol combined with IV amiodarone in ICD patients with electrical storm?
In ICD patients with electrical storm, the nonselective beta-blocker propranolol combined with IV amiodarone is superior to the beta-1 selective blocker metoprolol with IV amiodarone in reducing ventricular arrhythmias and ICD shocks.
Relative Risk: 0.375 (95% CI 0.207–0.678)
p-value: p=0.001
BACKGROUND: Electrical storm (ES), characterized by unrelenting recurrences of ventricular arrhythmias, is observed in approximately 30% of patients with implantable cardioverter-defibrillators (ICDs) and is associated with high mortality rates. OBJECTIVES: Sympathetic blockade with β-blockers, usually in combination with intravenous (IV) amiodarone, have proved highly effective in the suppression of ES. In this study, we compared the efficacy of a nonselective β-blocker (propranolol) versus a β METHODS: Between 2011 and 2016, 60 ICD patients (45 men, mean age 65.0 ± 8.5 years) with ES developed within 24 h from admission were randomly assigned to therapy with either propranolol (160 mg/24 h, Group A) or metoprolol (200 mg/24 h, Group B), combined with IV amiodarone for 48 h. RESULTS: Patients under propranolol therapy in comparison with metoprolol-treated individuals presented a 2.67 times decreased incidence rate (incidence rate ratio: 0.375; 95% confidence interval: 0.207 to 0.678; p = 0.001) of ventricular arrhythmic events (tachycardia or fibrillation) and a 2.34 times decreased rate of ICD discharges (incidence rate ratio: 0.428; 95% CI: 0.227 to 0.892; p = 0.004) during the intensive care unit (ICU) stay, after adjusting for age, sex, ejection fraction, New York Heart Association functional class, heart failure type, arrhythmia type, and arrhythmic events before ICU admission. At the end of the first 24-h treatment period, 27 of 30 (90.0%) patients in group A, while only 16 of 30 (53.3%) patients in group B were free of arrhythmic events (p = 0.03). The termination of arrhythmic events was 77.5% less likely in Group B compared with Group A (hazard ratio: 0.225; 95% CI: 0.112 to 0.453; p < 0.001). Time to arrhythmia termination and length of hospital stay were significantly shorter in the propranolol group (p < 0.05 for both). CONCLUSIONS: The combination of IV amiodarone and oral propranolol is safe, effective, and superior to the combination of IV amiodarone and oral metoprolol in the management of ES in ICD patients.
“The results clearly indicate that propranolol is a better antiarrhythmic drug than metoprolol for acute treatment of ES in those patients who have already received amiodarone.”
Chatzidou et al. (Mon,) conducted a rct in Electrical storm in patients with implantable cardioverter-defibrillators (n=60). Propranolol vs. Metoprolol (200 mg/24 h) was evaluated on Incidence rate of ventricular arrhythmic events (tachycardia or fibrillation) during the intensive care unit stay (IRR 0.375, 95% CI 0.207-0.678, p=0.001). Propranolol combined with IV amiodarone reduced the incidence of ventricular arrhythmic events compared to metoprolol (IRR 0.375; 95% CI 0.207-0.678; p=0.001) in ICD patients with electrical storm.