Abstract
Background
The protective effect of beta-blockers in patients with inherited Long-QT syndrome is well established. Recent reports have suggested that beta-blockers are not equally effective in Long-QT (LQT). Bisoprolol is an attractive candidate for use in LQT because of its cardioselective properties and favorable side-effect profile.
Methods
We performed a retrospective cohort study of 114 consecutive patients with gene-positive Long-QT syndrome type 1 (LQT1) or Long-QT syndrome type 2 (LQT2) treated with bisoprolol, nadolol or atenolol with a total of 580 person-years of follow-up. Electrocardiogram (ECG) parameters and cardiac events during follow-up were compared. In addition, exercise treadmill testing was performed in bisoprolol-treated patients.
Results
Fifty-nine patients were treated with bisoprolol, 39 with atenolol and 16 with nadolol. Overall, 59 % were females and 62 % had LQT1. Baseline heart rate and corrected QT (QTc) interval were similar between the groups. QTc shortening was observed in individuals on bisoprolol (ΔQTc −5 ± 31 ms; p = 0.049) and nadolol (ΔQTc −13 ± 16 ms; p = 0.02) but not on atenolol (ΔQTc +9 ± 24 ms; p = 0.16). Median follow-up was similar for bisoprolol and nadolol (3 years), but longer for atenolol (6 years; p = 0.03); one cardiac event occurred in the bisoprolol group (1.7 %) and two events occurred in the atenolol group (5.1 %; p = 0.45), whereas none occurred in nadolol-treated patients. Beta-blocker efficacy was not affected by the underlying genotype. The antiadrenergic effect of bisoprolol correlated with the reduction of peak heart rates at exercise testing.
Conclusions
Bisoprolol treatment results in QTc shortening in gene-positive LQT1 and LQT2 patients and is well tolerated during long-term administration. The equivalence of bisoprolol for protection from ventricular arrhythmia in LQT patients compared to established beta-blockers remains unknown. Further large-scale studies are required.
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Abbreviations
- BB:
-
Beta-blocker
- Bpm:
-
Beats per minute
- ECG:
-
Electrocardiogram
- HR:
-
Heart rate
- ICD:
-
Implantable cardioverter defibrillator
- IQR:
-
Interquartile range
- LQT:
-
Long-QT syndrome
- LQT1:
-
Long-QT syndrome type 1
- LQT2:
-
Long-QT syndrome type 2
- N/A:
-
Not applicable
- QTa:
-
Absolute QT interval
- QTc:
-
Corrected QT interval
- SCD:
-
Sudden cardiac death
- SD:
-
Standard deviation
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The study was approved by the local ethics and review board of each participating center.
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Supplementary Figure 1
Shown are the resting heart rates for LQTS-1 (A) and LQTS-2 (B) prior to beta-blocker initiation and on stable beta-blocker dose. Data are presented as mean ± SD. (TIFF 70 kb)
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Steinberg, C., Padfield, G.J., Al-Sabeq, B. et al. Experience with bisoprolol in long-QT1 and long-QT2 syndrome. J Interv Card Electrophysiol 47, 163–170 (2016). https://doi.org/10.1007/s10840-016-0161-2
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DOI: https://doi.org/10.1007/s10840-016-0161-2