Nadolol decreases the incidence and severity of ventricular arrhythmias during exercise stress testing compared with β₁-selective β-blockers in patients with catecholaminergic polymorphic ventricular tachycardia

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• 作者：Ida S. Leren ; MD^* ; ^&dagger ; ; ^&Dagger ; ; Jø ; rg Saberniak ; MD^* ; ^&dagger ; ; ^&Dagger ; ; ^$ ; Eman Majid^&Dagger ; ; Trine F. Haland ; MD^* ; ^&dagger ; ; ^&Dagger ; ; ^$ ; Thor Edvardsen ; MD ; PhD^* ; ^&dagger ; ; ^&Dagger ; ; ^$ ; Kristina H. Haugaa ; MD ; PhD^* ; ^&dagger ; ; ^&Dagger ; ; ^$ ; ^{Kristina.Haugaa@rr-research.no" class="auth_mail" title="E-mail the corresponding author}
• 关键词：CPVT ; catecholaminergic polymorphic ventricular tachycardia ; ECG ; electrocardiogram/electrocardiographic ; ICD ; implantable cardioverter-defibrillator ; NSVT ; nonsustained ventricular tachycardia ; RyR2 ; ryanodine receptor 2 ; SCA ; sudden cardiac arrest ; VES ; ventricular extrasystole ; VT ; ventricular tachycardia
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：13
• 期：2
• 页码：433-440
• 全文大小：674 K

文摘

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inheritable cardiac disease predisposing to malignant ventricular arrhythmias.

Objective

We aimed to explore the incidence and severity of ventricular arrhythmias in patients with CPVT before the initiation of β-blocker treatment, when treated with β₁-selective β-blockers, and when treated with nadolol.

Methods

In this study, 34 patients with CPVT were included (mean age 34 ± 19 years; 15 (44%) women; 30 (88%) ryanodine receptor 2 variant positive). We performed 3 bicycle exercise stress tests in each patient: (1) before the initiation of β-blocker treatment, (2) after >6 weeks of treatment with β₁-selective β-blockers and (3) after >6 weeks of treatment with nadolol. We recorded resting and maximum heart rates and the most severe ventricular arrhythmia occurring. Severity of arrhythmias was scored as 1 point for no arrhythmias or only single ventricular extrasystoles, 2 points for >10 ventricular extrasystoles per minute or bigeminy, 3 points for couplets, and 4 points for nonsustained ventricular tachycardia or sustained ventricular tachycardia.

Results

Resting heart rate was similar during treatment with nadolol and β₁-selective β-blockers (54 ± 10 beats/min vs 56 ± 14 beats/min; P = .50), while maximum heart rate was lower during treatment with nadolol compared with β₁-selective β-blockers (122 ± 21 beats/min vs 139 ± 24 beats/min; P = .001). Arrhythmias during exercise stress testing were less severe during treatment with nadolol compared with during treatment with β₁-selective β-blockers (arrhythmic score 1.6 ± 0.9 vs 2.5 ± 0.8; P < .001) and before the initiation of β-blocker treatment (arrhythmic score 1.6 ± 0.9 vs 2.7 ± 0.9; P = .001); however, no differences were observed during treatment with β₁-selective β-blockers compared with before the initiation of β-blocker treatment (arrhythmic score 2.5 ± 0.8 vs 2.7 ± 0.9; P = .46).

Conclusion

The incidence and severity of ventricular arrhythmias decreased during treatment with nadolol compared with during treatment with β₁-selective β-blockers. β₁-Selective β-blockers did not change the occurrence or severity of arrhythmias compared with no medication.