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

  • Ruwald M
  • Abu-Zeitone A
  • Jons C
  • et al.
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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




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.

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