Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
J Am Coll Cardiol. 2018 May 1;71(17):1897-1906. doi: 10.1016/j.jacc.2018.02.056.
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.
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-selective blocker (metoprolol) in the management of ES.
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.
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).
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.
电风暴（ES）的特征是无休止地反复发作室性心律失常，约 30%的植入式心脏复律除颤器（ICD）患者会出现这种情况，且与高死亡率相关。
使用β受体阻滞剂（通常与静脉内（IV）胺碘酮联合使用）进行交感神经阻滞已被证明对抑制 ES 非常有效。在这项研究中，我们比较了非选择性β受体阻滞剂（普萘洛尔）与β选择性阻滞剂（美托洛尔）在 ES 管理中的疗效。
在 2011 年至 2016 年间，60 名 ICD 患者（45 名男性，平均年龄 65.0 ± 8.5 岁）在入院后 24 小时内出现 ES，随机分配至接受普萘洛尔（160mg/24 h，A 组）或美托洛尔（200mg/24 h，B 组）治疗，联合 IV 胺碘酮治疗 48 小时。
与接受美托洛尔治疗的患者相比，接受普萘洛尔治疗的患者室性心律失常事件（心动过速或颤动）的发生率降低了 2.67 倍（发生率比：0.375；95%置信区间：0.207 至 0.678；p=0.001），ICD 放电率降低了 2.34 倍（发生率比：0.428；95%置信区间：0.227 至 0.892；p=0.004），这是在 ICU 住院期间发生的，校正年龄、性别、射血分数、纽约心脏协会功能分级、心力衰竭类型、心律失常类型和 ICU 入院前心律失常事件后得出的结果。在第一个 24 小时治疗期结束时，A 组 30 名患者中的 27 名（90.0%），而 B 组 30 名患者中的 16 名（53.3%）无心律失常事件（p=0.03）。与 A 组相比，B 组心律失常事件终止的可能性低 77.5%（风险比：0.225；95%置信区间：0.112 至 0.453；p<0.001）。B 组心律失常终止时间和住院时间明显短于 A 组（p<0.05）。
在 ICD 患者中，静脉内胺碘酮联合口服普萘洛尔安全、有效，优于静脉内胺碘酮联合口服美托洛尔。
