Document Detail


Not all beta-blockers are equal in the management of long QT syndrome types 1 and 2: higher recurrence of events under metoprolol.
MedLine Citation:
PMID:  23083782     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The purpose of this study was to compare the efficacy of beta-blockers in congenital long QT syndrome (LQTS).
BACKGROUND: Beta-blockers are the mainstay in managing LQTS. Studies comparing the efficacy of commonly used beta-blockers are lacking, and clinicians generally assume they are equally effective.
METHODS: Electrocardiographic and clinical parameters of 382 LQT1/LQT2 patients initiated on propranolol (n = 134), metoprolol (n = 147), and nadolol (n = 101) were analyzed, excluding patients <1 year of age at beta-blocker initiation. Symptoms before therapy and the first breakthrough cardiac events (BCEs) were documented.
RESULTS: Patients (56% female, 27% symptomatic, heart rate 76 ± 16 beats/min, QTc 472 ± 46 ms) were started on beta-blocker therapy at a median age of 14 years (interquartile range: 8 to 32 years). The QTc shortening with propranolol was significantly greater than with other beta-blockers in the total cohort and in the subset with QTc >480 ms. None of the asymptomatic patients had BCEs. Among symptomatic patients (n = 101), 15 had BCEs (all syncopes). The QTc shortening was significantly less pronounced among patients with BCEs. There was a greater risk of BCEs for symptomatic patients initiated on metoprolol compared to users of the other 2 beta-blockers combined, after adjustment for genotype (odds ratio: 3.95, 95% confidence interval: 1.2 to 13.1, p = 0.025). Kaplan-Meier analysis showed a significantly lower event-free survival for symptomatic patients receiving metoprolol compared to propranolol/nadolol.
CONCLUSIONS: Propranolol has a significantly better QTc shortening effect compared to metoprolol and nadolol, especially in patients with prolonged QTc. Propranolol and nadolol are equally effective, whereas symptomatic patients started on metoprolol are at a significantly higher risk for BCEs. Metoprolol should not be used for symptomatic LQT1 and LQT2 patients.
Authors:
Priya Chockalingam; Lia Crotti; Giulia Girardengo; Jonathan N Johnson; Katy M Harris; Jeroen F van der Heijden; Richard N W Hauer; Britt M Beckmann; Carla Spazzolini; Roberto Rordorf; Annika Rydberg; Sally-Ann B Clur; Markus Fischer; Freek van den Heuvel; Stefan Kääb; Nico A Blom; Michael J Ackerman; Peter J Schwartz; Arthur A M Wilde
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-10-17
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  60     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-09     Completed Date:  2013-01-29     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2092-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenergic beta-Antagonists / pharmacology,  therapeutic use*
Adult
Child
Disease-Free Survival
Electrocardiography / drug effects
Female
Humans
Long QT Syndrome / drug therapy*,  mortality
Male
Metoprolol / pharmacology,  therapeutic use*
Nadolol / pharmacology,  therapeutic use*
Prognosis
Propranolol / pharmacology,  therapeutic use*
Recurrence / prevention & control
Survival Analysis
Treatment Outcome
Young Adult
Grant Support
ID/Acronym/Agency:
GGP09247//Telethon; R01 HL068880/HL/NHLBI NIH HHS; R01 HL083374/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 42200-33-9/Nadolol; 9Y8NXQ24VQ/Propranolol; GEB06NHM23/Metoprolol
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2012 Nov 13;60(20):2100-2   [PMID:  23083777 ]

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