卡维地洛与美托洛尔对植入式心脏复律除颤器患者房性和室性心律失常的影响。

Effect of Carvedilol vs Metoprolol on Atrial and Ventricular Arrhythmias Among Implantable Cardioverter-Defibrillator Recipients.

机构信息

University of Rochester Medical Center, Clinical Cardiovascular Research Center, Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA.

出版信息

JACC Clin Electrophysiol. 2023 Oct;9(10):2122-2131. doi: 10.1016/j.jacep.2023.06.009. Epub 2023 Aug 30.

DOI:10.1016/j.jacep.2023.06.009

PMID:37656097

Abstract

BACKGROUND

Both selective and nonselective beta-blockers are used to treat patients with heart failure (HF). However, the data on the association of beta-blocker type with risk of atrial arrhythmia and ventricular arrhythmia (VA) in HF patients with a primary prevention implantable cardioverter-defibrillator (ICD) are limited.

OBJECTIVES

This study sought to evaluate the effect of metoprolol vs carvedilol on the risk of atrial tachyarrhythmia (ATA) and VA in HF patients with an ICD.

METHODS

This study pooled primary prevention ICD recipients from 5 landmark ICD trials (MADIT-II, MADIT-CRT, MADIT-RIT, MADIT-RISK, and RAID). Fine and Gray multivariate regression models, stratified by study, were used to evaluate the risk of ATA, inappropriate ICD shocks, and fast VA (defined as ventricular tachycardia ≥200 beats/min or ventricular fibrillation) by beta-blocker type.

RESULTS

Among 4,194 patients, 2,920 (70%) were prescribed carvedilol and 1,274 (30%) metoprolol. The cumulative incidence of ATA at 3.5 years was 11% in patients treated with carvedilol vs 15% in patients taking metoprolol (P = 0.003). Multivariate analysis showed that carvedilol treatment was associated with a 35% reduction in the risk of ATA (HR: 0.65; 95% CI: 0.53-0.81; P < 0.001) when compared to metoprolol, and with a corresponding 35% reduction in the risk of inappropriate ICD shocks (HR: 0.65; 95% CI: 0.47-0.89; P = 0.008). Carvedilol vs metoprolol was also associated with a 16% reduction in the risk of fast VA. However, these findings did not reach statistical significance (HR: 0.84; 95% CI: 0.70-1.02; P = 0.085).

CONCLUSIONS

These findings suggests that HF patients with ICDs on carvedilol treatment experience a significantly lower risk of ATA and inappropriate ICD shocks when compared to treatment with metoprolol.

摘要

背景

选择性和非选择性β受体阻滞剂均用于治疗心力衰竭（HF）患者。然而，关于β受体阻滞剂类型与具有一级预防植入式心脏复律除颤器（ICD）的 HF 患者的房性心律失常和室性心律失常（VA）风险之间关联的数据有限。

目的

本研究旨在评估美托洛尔与卡维地洛对具有 ICD 的 HF 患者的房性心动过速（ATA）和 VA 风险的影响。

方法

本研究汇总了 5 项里程碑式 ICD 试验（MADIT-II、MADIT-CRT、MADIT-RIT、MADIT-RISK 和 RAID）中的原发性预防 ICD 受者。采用 Fine 和 Gray 多变量回归模型，按研究分层，评估了β受体阻滞剂类型与 ATA、不适当 ICD 电击和快速 VA（定义为室性心动过速≥200 次/分或心室颤动）的风险。

结果

在 4194 例患者中，2920 例（70%）接受了卡维地洛治疗，1274 例（30%）接受了美托洛尔治疗。在 3.5 年时，接受卡维地洛治疗的患者中 ATA 的累积发生率为 11%，而接受美托洛尔治疗的患者中为 15%（P=0.003）。多变量分析显示，与美托洛尔相比，卡维地洛治疗可使 ATA 风险降低 35%（HR：0.65；95%CI：0.53-0.81；P<0.001），不适当 ICD 电击的风险降低 35%（HR：0.65；95%CI：0.47-0.89；P=0.008）。卡维地洛与美托洛尔相比，快速 VA 的风险也降低了 16%。然而，这些发现没有达到统计学意义（HR：0.84；95%CI：0.70-1.02；P=0.085）。