Impact of metoprolol use in the treatment of patients with electrical-storm after cardioverter defibrillators implantation
10.3760/cma.j.issn.0253-3758.2011.08.007
- VernacularTitle:美托洛尔在治疗置入型心律转复除颤器术后电风暴中的应用
- Author:
Jin-Bo YU
1
;
Bing YANG
;
Dong-Jie XU
;
Ming-Long CHEN
;
Qi-Jun SHAN
;
Jian-Gang ZOU
;
Chun CHEN
;
Feng-Xiang ZHANG
;
Xiao-Feng HOU
;
Wen-Qi LI
;
Rong ZHANG
;
Ke-Jiang CAO
Author Information
1. 南京医科大学附属第一医院
- Keywords:
Metoprolol;
Defibrillators,implantable;
Arrhythmia;
Electrical-storm
- From:
Chinese Journal of Cardiology
2011;39(8):717-720
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the effectiveness of the metoprolol dosage adjustment on reducing the incidence of electrical-storm (ES) in patients with Implantable Cardioverter Defibrillators (ICDs).Methods Data from patients with ICD implantation between Jan, 2003 and Jun, 2006 in our hospital were retrospectively analyzed. ES was defined as either ≥ 3 times of ventricular tachyarrhythmias (VTAs)resulting in ICD therapy or VTAs lasting more than 30 s detected by ICD without any therapy within 24 hours. Results During a follow-up period of (27.5 ± 21.2)months, ES was recorded in 39 cases [34 males, average age (52. 0 ± 13. 1 )years] out of 119 patients (32. 8% ) and 9 patients died after ES. During the period of storm attack, ES was successfully controlled in 25/30 patients by various interventions,including predisposing factors corrected in 5 cases, ICD reprogramming and antiarrhythmic drugs therapy optimized in 16 cases (one received intravenous injection of metoprolol), and VTAs eliminated by catheter ablation in 4 cases. ES was spontaneously resolved in the remaining 5 cases. In the chronic phase, 2 patients with Brugada syndrome were treated with Quinidine mono-therapy while the dosage of metoprolol was adjusted in the remaining 23 patients and the dosage of metoprolol was increased gradually from (26. 8 ±13.9)mg/d to (88.9 ± 53.5 )mg/d without any adverse effects (9 patients received also oral amiodarone 200 mg/d). Post dosage adjustment, the total VTA episodes [( 1.9 ± 1.7 ) times/month vs. (0. 8 ± 0. 6)times/month, P = 0. 004], incidence of antitachycardia pacing therapies [(4. 2 ± 3. 8 ) runs/month vs.(2. 3 ± 2. 0) runs/month, P = 0. 003], as well as electrical cardioversion or defibrillation [( 1.1 ± 0. 9 )times/month vs. (0. 4 ± 0. 2)times/month, P = 0. 001] were significantly decreased. ES was not controlled until a extremely high dosage [225 -300(255. 3 ±41.7)mg/d] of metoprolol was reached in the remaining 5 patients. Conclusions Metoprolol use is essential and its dosage should be individualized in the majority of ICD recipients with ES. In approximately 1/6 patients, the dosage of metoprolol should be higher than 200mg/d.
