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Effect of Carvedilol vs Metoprolol on Atrial and Ventricular Arrhythmias Among Implantable Cardioverter-Defibrillator
Alexander Diamond1, Ilan Goldenberg1, Arwa Younis1
1University of Rochester Medical Center, Clinical Cardiovascular Research Center, Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA.
Insights
Carvedilol significantly reduces the risk of atrial tachyarrhythmia and inappropriate ICD shocks in heart failure patients with an implantable cardioverter-defibrillator (ICD) compared to metoprolol.
Area of Science:
- Cardiology
- Pharmacology
- Medical Devices
Background:
- Heart failure (HF) management involves beta-blockers, but data on specific types and arrhythmia risk in patients with primary prevention implantable cardioverter-defibrillators (ICDs) are limited.
- Understanding the differential effects of beta-blocker selectivity is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the efficacy of carvedilol versus metoprolol in reducing atrial tachyarrhythmia (ATA) and ventricular arrhythmia (VA) risk.
- To assess the impact of beta-blocker type on inappropriate ICD shocks in HF patients.
Main Methods:
- Pooled analysis of primary prevention ICD recipients from five major ICD trials.
- Fine and Gray multivariate regression models were used to analyze risks stratified by study.
- Outcomes assessed included ATA, inappropriate ICD shocks, and fast ventricular arrhythmia (VA).
Main Results:
- Carvedilol was associated with a 35% reduction in ATA risk (HR: 0.65; P < 0.001) and inappropriate ICD shocks (HR: 0.65; P = 0.008) compared to metoprolol.
- The cumulative incidence of ATA at 3.5 years was lower with carvedilol (11%) than metoprolol (15%).
- A trend towards reduced fast VA risk with carvedilol did not reach statistical significance (HR: 0.84; P = 0.085).
Conclusions:
- Carvedilol treatment is associated with a significantly lower risk of ATA and inappropriate ICD shocks in HF patients with ICDs compared to metoprolol.
- These findings support carvedilol as a potentially preferred beta-blocker in this patient population.
- Further research may clarify the role of carvedilol in preventing ventricular arrhythmias.
Background:
Both selective and nonselective beta-blockers are used to treat patients with heart failure (HF). However, the data on the association of beta-blocker type with risk of atrial arrhythmia and ventricular arrhythmia (VA) in HF patients with a primary prevention implantable cardioverter-defibrillator (ICD) are limited.
Objectives:
This study sought to evaluate the effect of metoprolol vs carvedilol on the risk of atrial tachyarrhythmia (ATA) and VA in HF patients with an ICD.
Methods:
This study pooled primary prevention ICD recipients from 5 landmark ICD trials (MADIT-II, MADIT-CRT, MADIT-RIT, MADIT-RISK, and RAID). Fine and Gray multivariate regression models, stratified by study, were used to evaluate the risk of ATA, inappropriate ICD shocks, and fast VA (defined as ventricular tachycardia ≥200 beats/min or ventricular fibrillation) by beta-blocker type.
Results:
Among 4,194 patients, 2,920 (70%) were prescribed carvedilol and 1,274 (30%) metoprolol. The cumulative incidence of ATA at 3.5 years was 11% in patients treated with carvedilol vs 15% in patients taking metoprolol (P = 0.003). Multivariate analysis showed that carvedilol treatment was associated with a 35% reduction in the risk of ATA (HR: 0.65; 95% CI: 0.53-0.81; P < 0.001) when compared to metoprolol, and with a corresponding 35% reduction in the risk of inappropriate ICD shocks (HR: 0.65; 95% CI: 0.47-0.89; P = 0.008). Carvedilol vs metoprolol was also associated with a 16% reduction in the risk of fast VA. However, these findings did not reach statistical significance (HR: 0.84; 95% CI: 0.70-1.02; P = 0.085).
Conclusions:
These findings suggests that HF patients with ICDs on carvedilol treatment experience a significantly lower risk of ATA and inappropriate ICD shocks when compared to treatment with metoprolol.
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