Therapeutic Inefficacy and Proarrhythmic Nature of Metoprolol Succinate and Carvedilol Therapy in Patients With Idiopathic, Frequent, Monomorphic Premature Ventricular Contractions
Makaleler > Tam Makale · 2021
Yazarlar: OĞUZHAN EKREM TURAN, Mehmet Aydin, Ahmet Yener Odabasi, Mustafa Inc, Serdar PAYZIN, Can HASDEMİR
AMERICAN JOURNAL OF THERAPEUTICS, SCI Expanded İndekslerine Giren Dergi, Uluslararası, 2021, cilt 29, ss e34-e42
DOI: 10.1097/mjt.0000000000001372
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.