Nadolol decreases the incidence and severity of ventricular arrhythmias during exercise stress testing compared with β1-selective β-blockers in patients with catecholaminergic polymorphic ventricular tachycardia

Leren, Ida Skrinde; Saberniak, Jørg; Majid, Eman; Håland, Trine F.; Edvardsen, Thor; Haugaa, Kristina H.

doi:10.1016/j.hrthm.2015.09.029

Cited by 90 publications

(49 citation statements)

References 33 publications

(39 reference statements)

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“…48 Nadolol was also associated with a lower maximum heart rate and arrhythmia score compared with β1-selective β-blockers. A possible explanation for the favorable effect could be that nadolol has a more pronounced chronotropic effect than other types of β-blockers.…”

Section: Electrophysiological and Genetic Backgroundmentioning

confidence: 96%

“…Even though no robust comparison between the efficacy of the different type of β-blockers has been performed, reports indicate that the unselective β-blocker nadolol may be superior to other types of β-blockers. 7, 48 Hayashi et al observed lower cardiac event rates in patients treated with nadolol compared with other β-blockers and found that treatment with another type of β -blocker then nadolol was an independent risk factor for cardiac events (hazard ratio 3.12; 95% confidence interval [CI] 1.16-8.38; P=0.02). 7 Of note, that study did not indicate which type and dose of β-blocker the patients who were not on nadolol were receiving.…”

Section: β-Blockersmentioning

confidence: 99%

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Catecholaminergic Polymorphic Ventricular Tachycardia

Lieve

Werf

Wilde

2016

Circ J

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Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited cardiac arrhythmia disorder that is characterized by emotion-and exercise-induced polymorphic ventricular arrhythmias and may lead to sudden cardiac death (SCD). CPVT plays an important role in SCD in the young and therefore recognition and adequate treatment of the disease are of vital importance. In the past years tremendous improvements have been made in the diagnostic methods and treatment of the disease. In this review, we summarize the clinical characteristics, genetics, and diagnostic and therapeutic strategies of CPVT and describe the most recent advances and some of the current challenges. (Circ J 2016; 80: 1285 -1291

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Section: Electrophysiological and Genetic Backgroundmentioning

confidence: 96%

Section: β-Blockersmentioning

confidence: 99%

Catecholaminergic Polymorphic Ventricular Tachycardia

Lieve

Werf

Wilde

2016

Circ J

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“…Patients who received appropriate shock therapy were younger than those that did not. In 2015, Leren et al showed that the non-selective beta-blocker nadolol reduced exercise test-related arrhythmic events compared with β-1-selective beta-blockers 25. The same effect has been demonstrated with flecainide in 2011 22.…”

Section: Discussionmentioning

confidence: 94%

“…We cannot rule out that fewer shock episodes would have occurred in our cohort if other medical antiarrhythmic treatment had been used. However, 88% of the shock episodes were prior to the study by Leren et al 25 Finally, only six shock episodes were received after flecainide was proven to be effective in preventing ventricular arrhythmias in CPVT 22. Fifty per cent of these shocks were first shock received by the patient.…”

Section: Discussionmentioning

confidence: 99%

Nationwide experience of catecholaminergic polymorphic ventricular tachycardia caused by RyR2 mutations

Broendberg

Nielsen

Bjerre

et al. 2017

Heart

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“…Eight of 9 events did not occur during athletic competition. Additional contributors included medication noncompliance, a missed dose, or use of metoprolol, which has recently been shown to be inferior to nadolol in a population who received both medications(5). Simply put, no events would have been prevented by activity restriction, and 4 of 9 events are not readily explicable, especially without the granularity of timing of medication dose, intercurrent illness, and other modulators of autonomic tone.…”

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confidence: 99%

Catecholaminergic Polymorphic Ventricular Tachycardia

Krahn

Sanatani

2016

JACC: Clinical Electrophysiology

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Children very quickly learned how to avoid the stress that might trigger the light-headedness." -From Leenhardt's seminal report on the first pediatric CPVT cohort (1)T he practice of wise physicians recommending activity restriction in the setting of heart disease is woven into the fabric of cardiology.Until quite recently, "bed rest" was standard care for many common conditions, including myocardial infarction, rheumatic fever, and Kawasaki disease.Three decades ago we learned that patients with heart failure were best off with beta-blocker-induced "bed rest" after inotropic and adrenergic stimulation in heart failure not only failed to improve outcomes but also placed patients in harm's way. In the realm of adrenergically triggered arrhythmias, immense emphasis has been placed on ultracautious prevention of triggers that lead to events (2), arguably more so than on the development of rigorous evidence to titrate and deliver effective medical and interventional therapies to protect patients and liberate them to be more active.It has been just more than a decade since a group of experts came together to deliberate on exercise recommendations across a broad range of cardiac conditions, armed with very little data on which to base understandably conservative recommendations (2). Dr. Ackerman coauthored the Bethesda recommendations stating that "Symptomatic patients (with catecholaminergic polymorphic ventricular tachycardia [CPVT]) have a poor prognosis unless treated with an implantable cardioverter-defibrillator (ICD), and all such patients are restricted from competitive sports with the possible exception of minimal contact, Class 1A activities" (2). Since then, Ackerman and his team have been working to temper this edict with data. In this issue of JACC: Clinical Electrophysiology, Ostby et al. (3) report their experience with a cohort of patients diagnosed with CPVT, one-third of whom chose to continue with athletic participation after consultation at the renowned Mayo Clinic's specialized inherited heart rhythm clinic. We do not have all the details we would likeabout the population, such as whether the patient is the proband or a symptomatic relative, whether this is a "reassigned" diagnosis, whether the patient is seeking a review of athletic exclusion, or what is meant by "clinical risk profile." However, we can glean that the population is primarily referral based with a consensus statement-supported diagnosis of CPVT at a mean age of 16 years. At the time of the retrospective analysis, 79% of the group was highly treated with beta-blockers, and 35% were treated with flecainide; 32% had an ICD and 30% had previous sympathetic denervation. The temporal management of medical therapy is not described in response to intake or subsequent clinical status, but we are provided with helpful specifics about drug selection and titration.

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Nadolol decreases the incidence and severity of ventricular arrhythmias during exercise stress testing compared with β1-selective β-blockers in patients with catecholaminergic polymorphic ventricular tachycardia

Abstract: The incidence and severity of ventricular arrhythmias decreased during treatment with nadolol compared with during treatment with β1-selective β-blockers. β1-Selective β-blockers did not change the occurrence or severity of arrhythmias compared with no medication.

Cited by 90 publications

References 33 publications

Catecholaminergic Polymorphic Ventricular Tachycardia

Catecholaminergic Polymorphic Ventricular Tachycardia

Nationwide experience of catecholaminergic polymorphic ventricular tachycardia caused by RyR2 mutations

Catecholaminergic Polymorphic Ventricular Tachycardia

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