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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Not all beta-blockers are equal in the management of long QT syndrome types 1 and 2: Higher recurrence of events under metoprolol
Journal of the American College of Cardiology, Volume 60, No. 20, Year 2012
Notification
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Description
Objectives: The purpose of this study was to compare the efficacy of beta-blockers in congenital long QT syndrome (LQTS). Background: Beta-blockers are the mainstay in managing LQTS. Studies comparing the efficacy of commonly used beta-blockers are lacking, and clinicians generally assume they are equally effective. Methods: Electrocardiographic and clinical parameters of 382 LQT1/LQT2 patients initiated on propranolol (n = 134), metoprolol (n = 147), and nadolol (n = 101) were analyzed, excluding patients <1 year of age at beta-blocker initiation. Symptoms before therapy and the first breakthrough cardiac events (BCEs) were documented. Results: Patients (56% female, 27% symptomatic, heart rate 76 ± 16 beats/min, QTc 472 ± 46 ms) were started on beta-blocker therapy at a median age of 14 years (interquartile range: 8 to 32 years). The QTc shortening with propranolol was significantly greater than with other beta-blockers in the total cohort and in the subset with QTc >480 ms. None of the asymptomatic patients had BCEs. Among symptomatic patients (n = 101), 15 had BCEs (all syncopes). The QTc shortening was significantly less pronounced among patients with BCEs. There was a greater risk of BCEs for symptomatic patients initiated on metoprolol compared to users of the other 2 beta-blockers combined, after adjustment for genotype (odds ratio: 3.95, 95% confidence interval: 1.2 to 13.1, p = 0.025). Kaplan-Meier analysis showed a significantly lower event-free survival for symptomatic patients receiving metoprolol compared to propranolol/nadolol. Conclusions: Propranolol has a significantly better QTc shortening effect compared to metoprolol and nadolol, especially in patients with prolonged QTc. Propranolol and nadolol are equally effective, whereas symptomatic patients started on metoprolol are at a significantly higher risk for BCEs. Metoprolol should not be used for symptomatic LQT1 and LQT2 patients. © 2012 American College of Cardiology Foundation.
Authors & Co-Authors
Chockalingam, Priya
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Netherlands, Amsterdam
Emma Kinderziekenhuis
CROTTI, L.
Italy, Pavia
Università Degli Studi Di Pavia
Germany, Oberschleissheim
Helmholtz Center Munich German Research Center for Environmental Health
Girardengo, Giulia
Italy, Pavia
Università Degli Studi Di Pavia
Johnson, Jonathan N.
United States, Rochester
Mayo Clinic
Harris, Katy M.
United States, Rochester
Mayo Clinic
van der Heijden, Jeroen F.
Netherlands, Utrecht
University Medical Center Utrecht
Hauer, Richard N.W.
Netherlands, Utrecht
University Medical Center Utrecht
Beckmann, B. M.
Germany, Munich
Klinikum Der Universität München
Spazzolini, Carla
Italy, Pavia
Università Degli Studi Di Pavia
Rordorf, R.
Italy, Pavia
Fondazione Irccs Policlinico San Matteo
Rydberg, Annika M.
Sweden, Umea
Umeå Universitet
Clur, Sally Ann B.
Netherlands, Amsterdam
Emma Kinderziekenhuis
Fischer, Markus
Germany, Heidelberg
Universitätsklinikum Heidelberg
van den Heuvel, Freek
Netherlands, Groningen
Beatrix Kinderziekenhuis
Kääb, Stefan
Germany, Munich
Klinikum Der Universität München
Blom, Nico Andreas
Netherlands, Amsterdam
Emma Kinderziekenhuis
Netherlands, Leiden
Leids Universitair Medisch Centrum
Ackerman, Michael John
United States, Rochester
Mayo Clinic
Schwartz, Peter J.
Italy, Pavia
Università Degli Studi Di Pavia
South Africa, Cape Town
University of Cape Town
Saudi Arabia, Riyadh
College of Medicine
Wilde, Arthur A.M.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Statistics
Citations: 224
Authors: 19
Affiliations: 14
Identifiers
Doi:
10.1016/j.jacc.2012.07.046
ISSN:
07351097
e-ISSN:
15583597
Research Areas
Genetics And Genomics
Noncommunicable Diseases
Study Design
Cohort Study
Case-Control Study
Participants Gender
Female