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Heart rate control with single administration of a long-acting β-blocker at bedtime before coronary computed
Kenji Sadamatsu1, Sachiko Koide2, Kayoko Nakano2
1Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan.
Insights
Administering a long-acting beta-blocker the night before coronary CT angiography effectively lowers heart rate. This strategy helps patients achieve the target heart rate for optimal imaging.
Area of Science:
- Cardiology
- Radiology
- Pharmacology
Background:
- Beta-blockers are crucial for heart rate control before coronary CT angiography.
- In-hospital beta-blocker administration is inefficient and often fails to reach target heart rates (<60 bpm).
- Achieving target heart rates is essential for successful coronary CT angiography.
Purpose of the Study:
- To evaluate the efficacy of a single, bedtime dose of a long-acting beta-blocker for heart rate control prior to coronary CT angiography.
- To determine if this strategy improves the achievement of target heart rates compared to standard practice.
Main Methods:
- Retrospective analysis of 314 patients with resting heart rate >60 bpm undergoing coronary CT angiography.
- Patients received either a nightly oral dose of bisoprolol or atenolol (beta group, n=166) or no pre-procedural medication (control group, n=148).
- Physician-administered oral beta-blockers or verapamil were used for heart rates >60 bpm upon arrival if needed.
Main Results:
- The beta group showed significantly reduced heart rates upon arrival and during angiography compared to the control group.
- A higher proportion of patients in the beta group achieved a heart rate ≤60 bpm on arrival, even with additional treatments.
- Baseline heart rates were similar between groups, indicating the nightly dose was the primary factor.
Conclusions:
- Single, bedtime administration of a long-acting beta-blocker is an effective method for achieving target heart rates before coronary CT angiography.
- This approach offers a practical and efficient alternative to in-hospital beta-blocker administration.
- Optimizing heart rate control with nightly beta-blockers can enhance the quality and success rate of coronary CT angiography.
Background:
Beta-blockers are used to control the heart rate prior to coronary computed tomography (CT) angiography. However, in-hospital administration is time-consuming, and it is hard to decrease the heart rate to <60 beats per minute (bpm) when the initial heart rate is increased. In this study, we examined whether the single administration of long-acting β-blocker at bedtime before angiography is effective for achieving the target heart rate.
Methods And Results:
A total of 314 consecutive patients with a resting heart rate >60bpm who underwent coronary CT angiography were retrospectively collected. Either bisoprolol or atenolol was orally administered the night before to 166 patients (beta group), and no additional medication was administered to the other 148 patients (control group). When the heart rate was >60bpm on arrival, a β-blocker or verapamil was orally administered at the discretion of the physician. Although the baseline heart rate was not significantly different between the groups, the β-blocker treatment the night before significantly reduced the heart rate compared to control group upon arrival at the hospital and at the time of angiography. The rate of achievement of a heart rate ≤60bpm on arrival at the hospital was significantly higher in the beta group, and even after the additional treatment.
Conclusions:
Bedtime administration of a long-acting β-blocker the night before coronary CT angiography is an effective option to achieve the target heart rate at the time of examination.
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