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Title: | Reduced occurrence of appropriate therapy for ventricular arrhythmias after beta-blocker uptitration following implant of a primary prevention CRT-defibrillator | Authors: | MARTENS, Pieter DUPONT, Matthias MULLENS, Wilfried |
Issue Date: | 2020 | Publisher: | TAYLOR & FRANCIS LTD | Source: | Acta Cardiologica, 75 (1) , p. 49 -53 | Abstract: | Background: Absence of beta-blocker use independently predicts appropriate therapy. Following cardiac resynchronisation therapy (CRT) implant, reverse remodelling and protection against bradycardia allows for beta-blocker dose uptitration. The differential dosing effects on the occurrence of a first episode of appropriate therapy in primary prevention CRT-defibrillator (CRT-D) patients remains unstudied. Methods and Results: Changes in beta-blocker dose following CRT-D in consecutive primary prevention patients implanted between 2008 and 2015 were retrospectively studied. Beta-blocker dose was expressed as percent of target dose. Uptitration of beta-blocker dose following implant was calculated as the change in percent of target dose between implant and 6-months follow-up. Results from a prospectively maintained database of all device analysis were used to determine the occurrence of appropriate therapy. A total of 162 patients (68 +/- 8 years) were studied. One hundred and ten (68%) patients underwent uptitration (mean 47 +/- 19% in target dose) and 52 (32%) remained on a stable beta-blocker dose. During 37 +/- 22 months follow-up, the cumulative percent of appropriate therapy was 31% in patient receiving no-uptitration versus 10% in the uptitrated patients (p < 0.001). After correction for known predictors of appropriate therapy, uptitration was independently associated with an OR = 0.263 (CI = 0.103-0.675; p = 0.001) for the occurrence of appropriate therapy. Every 1%-increase in target dose for beta-blocker associated with a significant lower risk for appropriate therapy, OR = 0.982 (CI = 0.965-0.999; p = 0.042). Conclusion: Following implantation of a primary prevention CRT-D, uptitration of beta-blockers associated with a reduced occurrence of a first episode of appropriate therapy for ventricular arrhythmias. An inverse dose-response effect was seen between beta-blocker dose and appropriate therapy. | Notes: | Martens, P (reprint author), Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium. Pieter.martens2@zol.be |
Other: | Martens, P (reprint author), Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium. Pieter.martens2@zol.be | Keywords: | Beta-blockers;appropriate therapy;uptitration;implantable cardioverter defibrillation | Document URI: | http://hdl.handle.net/1942/30662 | ISSN: | 0001-5385 | e-ISSN: | 1784-973X | DOI: | 10.1080/00015385.2018.1547469 | ISI #: | WOS:000512642800007 | Rights: | 2020 Informa UK Limited | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2021 |
Appears in Collections: | Research publications |
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Reduced occurrence of appropriate therapy for ventricular arrhythmias after beta blocker uptitration following implant of a primary prevention CRT.pdf Restricted Access | Published version | 817.36 kB | Adobe PDF | View/Open Request a copy |
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