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Beta-blocker therapy is associated with a lower incidence of syncope due to fast ventricular tachycardias among implantable cardioverter-defibrillator patients with left ventricular dysfunction: results from a multicenter study

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Abstract

Introduction

Among implantable cardioverter-defibrillator (ICD) patients, a substantial proportion of syncopes are due to fast ventricular tachycardias (FVTs). In the experimental models of ventricular tachycardias, the arterial vasoconstriction plays an important role in recovering the arterial pressure. Since beta-blockers increase vascular resistance, we hypothesized that beta-blockers could reduce the occurrence of syncope due to FVTs. Our objective was to determine the relationship between the beta-blocker therapy and the incidence of syncope in FVT (cycle length [CL] 250–320 ms) occurring in ICD patients. Slow VTs were excluded because of the lack of symptoms and VF episodes because of the small number.

Methods and results

In this multicenter study, 226 patients (LVEF 31 ± 10%) with single-chamber ICDs were followed. FVT programming was standardized, including antitachycardia pacing (ATP) as initial therapy. Symptoms were correlated with ICD-stored episode data of FVTs. The beta-blocker therapy was determined at each FVT presentation. We analyzed 289 FVTs (CL 291 ± 21 ms; 77% under beta-blockers; median of the duration:8 s) occurring consecutively in 52 ICD patients. The frequency of FVT-related syncope was 22 (7.6%). Beta-blockers were associated with a lower heart rate preceding FVT (85 ± 22 vs. 94 ± 23 bpm; p = 0.009), a higher ATP effectiveness (86 vs. 57%; p < 0.001), a lower duration of episodes (8 [2] vs. 10 [14] s; p < 0.001), and a lower incidence of FVT-related syncope (4.5 vs. 18%; p < 0.001). By logistic regression, a FVT > 8 s (OR = 21; p = 0.003) and the beta-blocker therapy (OR = 0.3; p = 0.012) were found as independent predictors of syncope.

Conclusion

Among ICD patients with left ventricular dysfunction, beta-blockers are associated with a lower incidence of FVT-related syncope.

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Abbreviations

ICD:

Implantable cardioverter-defibrillator

ATP:

Antitachycardia pacing

LVEF:

Left ventricular ejection fraction

FVT:

Fast ventricular tachycardia

CL:

Cycle length

OR:

Odds ratio

IDE-BB:

Indexed dose of beta-blockers

CI:

Confidence interval

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Authors and Affiliations

  1. Cardiology Department, IBSAL-University Hospital, School of Medicine, University of Salamanca, CIVERCV, Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain

    Javier Jiménez-Candil, Olga Durán, Jesús Hernández, José Luis Moríñigo, Ana Martín, Loreto Bravo & Pedro Luis Sánchez

  2. Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

    Ignasi Anguera, Paolo Dallaglio & Andrea di Marco

  3. Hospital San Pedro de Alcántara, Cáceres, Spain

    Javier Fernández-Portales

Authors
  1. Javier Jiménez-Candil
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  2. Ignasi Anguera
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  3. Olga Durán
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  4. Jesús Hernández
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  5. Javier Fernández-Portales
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  6. José Luis Moríñigo
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  7. Ana Martín
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  8. Paolo Dallaglio
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  9. Loreto Bravo
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  10. Andrea di Marco
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  11. Pedro Luis Sánchez
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Corresponding author

Correspondence to Javier Jiménez-Candil.

Ethics declarations

The study complied with the Declaration of Helsinki. The protocol was reviewed and accepted by the institutional review board of our institutions. A written informed consent was obtained from all patients.

Conflicts of interest

The authors declare that they have no conflict of interest.

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Jiménez-Candil, J., Anguera, I., Durán, O. et al. Beta-blocker therapy is associated with a lower incidence of syncope due to fast ventricular tachycardias among implantable cardioverter-defibrillator patients with left ventricular dysfunction: results from a multicenter study. J Interv Card Electrophysiol 52, 69–76 (2018). https://doi.org/10.1007/s10840-018-0344-0

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