Javier Jiménez-Candil1, Ignasi Anguera2, Olga Durán3, Jesús Hernández3, Javier Fernández-Portales4, José Luis Moríñigo3, Ana Martín3, Paolo Dallaglio2, Loreto Bravo3, Andrea di Marco2, Pedro Luis Sánchez3. 1. Cardiology Department, IBSAL-University Hospital, School of Medicine, University of Salamanca, CIVERCV, Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain. jimenezcandil@secardiologia.es. 2. Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 3. Cardiology Department, IBSAL-University Hospital, School of Medicine, University of Salamanca, CIVERCV, Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain. 4. Hospital San Pedro de Alcántara, Cáceres, Spain.
Abstract
INTRODUCTION: Among implantable cardioverter-defibrillator (ICD) patients, a substantial proportion of syncopes are due to fast ventricular tachycardias (FVTs). In the experimental models of ventricular tachycardias, the arterial vasoconstriction plays an important role in recovering the arterial pressure. Since beta-blockers increase vascular resistance, we hypothesized that beta-blockers could reduce the occurrence of syncope due to FVTs. Our objective was to determine the relationship between the beta-blocker therapy and the incidence of syncope in FVT (cycle length [CL] 250-320 ms) occurring in ICD patients. Slow VTs were excluded because of the lack of symptoms and VF episodes because of the small number. METHODS AND RESULTS: In this multicenter study, 226 patients (LVEF 31 ± 10%) with single-chamber ICDs were followed. FVT programming was standardized, including antitachycardia pacing (ATP) as initial therapy. Symptoms were correlated with ICD-stored episode data of FVTs. The beta-blocker therapy was determined at each FVT presentation. We analyzed 289 FVTs (CL 291 ± 21 ms; 77% under beta-blockers; median of the duration:8 s) occurring consecutively in 52 ICD patients. The frequency of FVT-related syncope was 22 (7.6%). Beta-blockers were associated with a lower heart rate preceding FVT (85 ± 22 vs. 94 ± 23 bpm; p = 0.009), a higher ATP effectiveness (86 vs. 57%; p < 0.001), a lower duration of episodes (8 [2] vs. 10 [14] s; p < 0.001), and a lower incidence of FVT-related syncope (4.5 vs. 18%; p < 0.001). By logistic regression, a FVT > 8 s (OR = 21; p = 0.003) and the beta-blocker therapy (OR = 0.3; p = 0.012) were found as independent predictors of syncope. CONCLUSION: Among ICD patients with left ventricular dysfunction, beta-blockers are associated with a lower incidence of FVT-related syncope.
INTRODUCTION: Among implantable cardioverter-defibrillator (ICD) patients, a substantial proportion of syncopes are due to fast ventricular tachycardias (FVTs). In the experimental models of ventricular tachycardias, the arterial vasoconstriction plays an important role in recovering the arterial pressure. Since beta-blockers increase vascular resistance, we hypothesized that beta-blockers could reduce the occurrence of syncope due to FVTs. Our objective was to determine the relationship between the beta-blocker therapy and the incidence of syncope in FVT (cycle length [CL] 250-320 ms) occurring in ICDpatients. Slow VTs were excluded because of the lack of symptoms and VF episodes because of the small number. METHODS AND RESULTS: In this multicenter study, 226 patients (LVEF 31 ± 10%) with single-chamber ICDs were followed. FVT programming was standardized, including antitachycardia pacing (ATP) as initial therapy. Symptoms were correlated with ICD-stored episode data of FVTs. The beta-blocker therapy was determined at each FVT presentation. We analyzed 289 FVTs (CL 291 ± 21 ms; 77% under beta-blockers; median of the duration:8 s) occurring consecutively in 52 ICDpatients. The frequency of FVT-related syncope was 22 (7.6%). Beta-blockers were associated with a lower heart rate preceding FVT (85 ± 22 vs. 94 ± 23 bpm; p = 0.009), a higher ATP effectiveness (86 vs. 57%; p < 0.001), a lower duration of episodes (8 [2] vs. 10 [14] s; p < 0.001), and a lower incidence of FVT-related syncope (4.5 vs. 18%; p < 0.001). By logistic regression, a FVT > 8 s (OR = 21; p = 0.003) and the beta-blocker therapy (OR = 0.3; p = 0.012) were found as independent predictors of syncope. CONCLUSION: Among ICDpatients with left ventricular dysfunction, beta-blockers are associated with a lower incidence of FVT-related syncope.
Authors: Javier Jiménez-Candil; Ignasi Anguera; Claudio Ledesma; Javier Fernández-Portales; José Luis Moríñigo; Paolo Dallaglio; Ana Martín; Teresa Cano; Jesús Hernández; Xavier Sabaté; Cándido Martín-Luengo Journal: J Cardiovasc Electrophysiol Date: 2013-09-09
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