Concomitant β-blocker therapy is associated with a lower occurrence of ventricular arrhythmias in patients with decompensated heart failure
Concomitant β-blocker therapy is associated with a lower occurrence of ventricular arrhythmias in patients with decompensated heart failure
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DOI：
10.1054/jcaf.2002.32946
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发表时间：
2002-04-01
影响因子：
6
通讯作者：
Burger, AJ
中科院分区：
文献类型：
--
作者：
Aronson, D;Burger, AJ
背景：室性心律失常几乎普遍存在于晚期充血性心力衰竭（CHF）患者中，并且是这些患者死亡的重要原因。 β-受体阻滞剂对心力衰竭猝死死亡率的有益作用的推定机制之一是它们抑制室性心律失常的能力。然而，CHF 患者的支持数据很少，特别是在与症状性失代偿性心力衰竭相关的神经体液过度激活的情况下。方法和结果：我们研究了 236 名因失代偿性 CHF 入院的患者（159 名男性；平均年龄为 61 +/- 14 岁）。研究期间，50 名患者正在接受 β 受体阻滞剂治疗。室性心律失常的严重程度通过 24 小时 Holler 记录并使用几种前瞻性定义的心室异位测量来评估。接受β受体阻滞剂治疗的患者心室异位的所有指标均较低。接受 β 受体阻滞剂治疗的患者每小时平均总室性早搏 (PVC)、每小时室性对联、重复室性早搏和室性心动过速发作频率分别降低 15% (P = .02)、75% (P < .05)、72% (P < .05) 和 87% (P = .01)。在多变量回归分析中，β 受体阻滞剂与平均每小时室性早搏 (P = .03)、心室对频率 (P = .03)、重复性室性心动过速 (P < .05) 和室性心动过速发作 (P = .01) 之间的负相关关系仍然显着且独立。室性心动过速发作。 β-受体阻滞剂的这种作用可能通过预防交感神经活动短暂增加期间的严重室性心律失常发挥重要的保护作用。
Background: Ventricular arrhythmias are nearly universally present in patients with advanced congestive heart failure (CHF) and represent an important cause of mortality in these patients. One of the putative mechanisms for the salutary effects of beta-blockers on sudden death mortality in heart failure is their ability to suppress ventricular arrhythmias. However, supporting data in patients with CHF are sparse, especially in the setting of excessive neurohumoral activation associated with symptomatic decompensated heart failure.Methods and Results: We studied 236 patients (159 men; mean age, 61 +/- 14 years) admitted for decompensated CHF. Fifty patients were receiving beta-blockers at the time of the study. The severity of ventricular arrhythmia was assessed by 24-hour Holler recordings by using several prospectively defined measures of ventricular ectopy. All measures of ventricular ectopy were lower in patients receiving beta-blockers. The average hourly total premature ventricular beats (PVCs), hourly ventricular couplets, repetitive PVCs, and frequency of ventricular tachycardia episodes were 15% (P = .02), 75% (P < .05), 72% (P < .05), and 87% (P = .01) lower in patient receiving beta-blockers, respectively. In a multivariate regression analysis, the negative relationship between beta-blockers and the average hourly PVCs (P = .03), the frequency of ventricular pairs (P =.03), repetitive PVCs (P < .05), and ventricular tachycardia episodes (P = .01) remained significant and independent.Conclusions: Concomitant beta-blocker therapy during heart failure decompensation is associated with a marked reduction in complex ventricular ectopy and episodes of ventricular tachycardia. This effect of beta-blockers may play an important protective role by preventing serious ventricular arrhythmias during transient increases in sympathetic activity.