Current Heart Failure Reports

, Volume 14, Issue 6, pp 529–535 | Cite as

Pharmacogenomics of Bucindolol in Atrial Fibrillation and Heart Failure

  • Kishan S. ParikhEmail author
  • Jonathan P. Piccini
Genetics of Heart Failure (K Adams, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Genetics of Heart Failure


Purpose of Review

We explore the pharmacogenomics of the beta-blocker bucindolol by discussing relevant beta-1 adrenergic receptor (ADRB1) polymorphisms and recent beta-blocker studies. Through this, we will understand how bucindolol may help patients with atrial fibrillation and heart failure with reduced ejection fraction (AF-HFrEF), which carries poor prognosis.

Recent Findings

Retrospective study of the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training trial revealed the interaction between the optimal beta-blocker dose and the ADRB1 Arg389 genotype for HFrEF clinical outcomes. Further, a combinatorial genotype analysis in the Beta-Blocker Evaluation of Survival Trial showed that the Arg389Arg genotype, but not the Gly carrier, was associated with 40% lower mortality risk with bucindolol. Finally, the AF-HFrEF subgroup with the ADRB1 Arg389Arg genotype had greater heart rate reduction and suggestion for mortality benefit.


Therapeutic response to beta-blockers varies by beta-blocker mechanism, ADRB1 Arg389 genotype, and clinical setting (AF, HFrEF, AF-HFrEF). The ongoing trial A Genotype-Directed Comparative Effectiveness Trial of Bucindolol and Toprol-XL for Prevention of Symptomatic Atrial Fibrillation/Atrial Flutter in Patients with Heart Failure prospectively identifies AF-HFrEF patients with favorable genotype for bucindolol to prevent AF recurrence.


Pharmacogenomics Bucindolol Heart failure Atrial fibrillation 


Compliance with Ethical Standards

Conflict of Interest

Kishan S. Parikh declares no conflict of interest. Jonathan P. Piccini has received grants from ARCA Biopharma and Johnson & Johnson, Boston Scientific, ResMed, Gilead, St Jude Medical, and Spectranetics. Dr. Piccini is also a consultant for Amgen, Spectranetics, Medtronic, Allergan, and Janssen Pharmaceuticals.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Duke Clinical Research InstituteDurhamUSA
  2. 2.Duke University Medical CenterDurhamUSA

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