Impact of Carvedilol and Metoprolol on Inappropriate Implantable Cardioverter-Defibrillator Therapy

  • Ruwald M
  • Abu-Zeitone A
  • Jons C
  • et al.
N/ACitations
Citations of this article
9Readers
Mendeley users who have this article in their library.

Abstract

Objectives The goal of this study was to evaluate the effects of<br />carvedilol and metoprolol on the endpoint of inappropriate implantable<br />cardioverter-defibrillator therapy in the MADIT-CRT (Multicenter<br />Automatic Defibrillator Implantation With Cardiac Resynchronization<br />Therapy) study.<br />Background The impact of carvedilol and metoprolol on inappropriate<br />therapy in heart failure patients with devices has not yet been<br />investigated.<br />Methods All patients in the MADIT-CRT study who received a device (N =<br />1,790) were identified. Using time-dependent Cox regression analysis, we<br />compared patients treated with different types of beta-blockers or no<br />beta-blockers on the primary endpoint of inappropriate therapy,<br />delivered as antitachycardia pacing (ATP) or shock therapy. Secondary<br />endpoints were inappropriate therapy due to atrial fibrillation and<br />atrial tachyarrhythmias, also evaluated as ATP or shock therapy.<br />Results Inappropriate therapy occurred in 253 (14%) of 1,790 patients<br />during a follow-up period of 3.4 +/- 1.1 years. Treatment with<br />carvedilol was associated with a significantly decreased risk of<br />inappropriate therapy compared with metoprolol (hazard ratio {[}HR]:<br />0.64 {[}95% confidence interval (CI): 0.48 to 0.85]; p = 0.002). The<br />reduction in risk was consistent for inappropriate ATP (HR: 0.66 {[}95%<br />CI: 0.48 to 0.90]; p = 0.009) and inappropriate shock therapy (HR: 0.54<br />{[}95% CI: 0.36 to 0.80]; p = 0.002). The risk of inappropriate therapy<br />caused by atrial fibrillation was also reduced in patients receiving<br />carvedilol compared with metoprolol (HR: 0.50 {[}95% CI: 0.32 to 0.81];<br />p = 0.004). General use of beta-blockers (93%) and adherence in this<br />study was high.<br />Conclusions In heart failure patients undergoing either cardiac<br />resynchronization therapy with a defibrillator or with an implantable<br />cardioverter-defibrillator device, carvedilol was associated with a 36%<br />lower rate of inappropriate ATP and shock therapy compared with<br />metoprolol. Inappropriate therapy due to atrial fibrillation was<br />associated with a 50% lower rate in patients receiving carvedilol<br />compared with those receiving metoprolol. (MADIT-CRT: Multicenter<br />Automatic Defibrillator Implantation With Cardiac Resynchronization<br />Therapy; NCT00180271) (c) 2013 by the American College of Cardiology<br />Foundation

Cite

CITATION STYLE

APA

Ruwald, M. H., Abu-Zeitone, A., Jons, C., Ruwald, A.-C., McNitt, S., Kutyifa, V., … Moss, A. J. (2013). Impact of Carvedilol and Metoprolol on Inappropriate Implantable Cardioverter-Defibrillator Therapy. Journal of the American College of Cardiology, 62(15), 1343–1350. https://doi.org/10.1016/j.jacc.2013.03.087

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free