Beta-blockers for the treatment of arrhythmias: Bisoprolol – a systematic review

Ventricular arrhythmias and sudden cardiac death

Sex differences have the potential to impact diagnostic and therapeutic interventions in a wide variety of medical conditions, and cardiac arrhythmias are no exception.1 Studies evaluating pathophysiology, disease course, and therapeutic options for cardiac arrhythmias have been performed predominantly in male patients. However, catheter and device-based therapies coupled with landmark clinical trials have contributed to an improved understanding of this important aspect. The objective of this review is to present the current state of knowledge on sex differences in cardiac arrhythmias with a focus on clinical management, while highlighting gaps in knowledge that would benefit from future investigation. ### Atrial Fibrillation and Atrial Flutter #### Disease Burden Atrial fibrillation (AF) and atrial flutter (AFL) are the most commonly encountered tachyarrhythmias in clinical practice, with significant implications for public health and healthcare costs. Stroke, hospitalization, and loss of productivity are the major consequences of AF.2 The incidence of AF (per 1000 person-years) is reported to be between 1.6 and 2.7 in women and between 3.8 and 4.7 in men.2 The age-adjusted incidence and prevalence of AF is lower in women compared with that in men, and accordingly, the lifetime risk of AF from the Framingham Heart Study at 40 years of age was higher in men (26.0% for men versus 23.0% for women).3 Another analysis from the Framingham Heart Study demonstrated no significant sex differences in the risk of developing AFL.4 The prevalence of AF continues to rise among both men and women. In a study investigating the global burden of disease from 1980 to 2010, there was not only an increase in overall burden, incidence, and prevalence of AF, but most importantly an increase in AF-associated mortality in both men and women (Figure 1).5 The age-adjusted mortality for women was consistently higher compared with that for men from 1990 to 2010 (Figure …

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A heat-treatment process for conditioning waxy crude oils, developed by Burmah Oil Co. and British Petroleum Co. Ltd., is used in the new 1.25 million ton Moran facility by Oil India Ltd. to make Assam crude pumpable during Indian winters. In the batch process used at the new facility, crude oil is initially heated in a vertical tube heater to 203/sup 0/-208/sup 0/F and then passed through a heat exchanger where it warms the incoming oil. After the crude oil cools to 149/sup 0/F, it passes into 14 conditioning vessels (treaters) where it is cooled under static conditions to about 64/sup 0/F at about 0.5/sup 0/-25/sup 0/F/min. The unit cost about $4 million to build and will cost about $0.15-$0.20/ton of crude oil to operate. Both capital and operating costs could be reduced by converting from batch to continuous operation, but pilot plant testing of the continuous process is still required.

Objective To retrospectively observe the efficacy of treatment of life-threatening ventricular arrhythmias by a combination of β-receptor blocker and temporary right ventricular pacing on adult cardiac disease patients after heart operation. Methods Eight patients with adult cardiac diseases occurring intractable ventricular tachycardia/ventricular fibrillation after operation from 1 week to 2 years postoperative from May 2004 to May 2016 were selected, including 2 males and 6 females, aged from 42 to 72 years, 7 patients were rheumatic heart valve disease and underwent valve replacement, 1 patient was coronary artery disease and under on pump CABG. The 6 cases were atrial fibrillation preoperatively, and 2 cases were sinus rhythm. β-receptor blocker esmolol injection was used immediately after defibrillation and combination with one or more the following drugs: amiodarone, lidocaine when malignant ventricular arrhythmia were found. The unipolar right ventricular temporary pacing was inserted when heart rate was less than 50-70 bpm and the malignant ventricular arrhythmia was not been effectively suppressed. The ventricular tachycardia or ventricular fibrillation was effectively controlled by combination with unipolar right ventricular VVI temporary pacing (pacing rate was 80-100 bpm). Patients were treated by non-invasive positive ventilation or intubated and invasively ventilated when lung function was worsen and treated by dopamine and and noradrenaline when heart function was worsen. The 24 h dynamic electrocardiogram was performed after the malignant ventricular arrhythmia were suppressed successfully viewed by bedside electrocardiogram monitor and right ventricular temporary pacer was with drew from after 24 h Holter was good. Results Eight patients all survived and discharged. Heart function wasn’t deteriorated, no patient had multiple organs failure, 24 h dynamic electrocardiogram showed premature ventricular beats were more than 1 000 beats in 1 case, and were 500-1 000 in 1 case, and less than 500 in 2 cases, and 2 times paroxysmal ventricular tachycardia in 2 cases and 3 times in 1 case. Eight cases were followed up for 2 months to 132 months. there was no recurrence of malignant ventricular arrhythmia, New York heart function grade was Ⅱ-Ⅲ in all 8 cases, 2 cases were readmitted for heart function failure at 1 year, 1 case died for non cardiac events at 1 year, 1 case died for end-stage coronary artery disease and myocardial infarction at 5 years after discharge. Conclusions Treatment of intractable life-threatening ventricular arrhythmias by a combination of β-receptor blocker and temporary right ventricular pacing in adult patients after valve replacement is safe and effectively and should be recommended. Key words: Right ventricular temporary pacing; β-receptor blocker; Adult cardiac disease; Ventricular tachycardia; Ventricular fibrillation

Objective To summarize and investigate the incidence,reason,diagnosis and treatment of postoperative early cardiac arrhythmia after orthotopic liver transplantation(OLT).Method A retrospective study was made for the incidence,dignosis and treatment of cardiac arrhythmia (two weeks after OLT) following OLT from June 2004 to January 2012 in the Beijing You-An Hospital.Results In 500 patients who received OLT,Cardiac arrhythmia developed in 82 patients (16.4％).Among these cardiac arrhythmia,35(7.0 ％) were sick sinus syndrome (including severe sinus bradycardia ),18 (3.6 ％ ) were paroxysmal supraventricular tachycardia,21(4.2 ％) were atrial fibrillation,8(1.6 ％,including 2 patients with torsades de pointes) were ventricular tachycardia and 4 (0.8 ％ )were cardiac arrest.Mortality rate after OLT relate to cardiac arrhythmia was 0.4％ (2 patients).Cardiac arrhythmia was mainly correlated with four factors:(1)whether patient had heart disease before OLT or not(x2 =15.82,P＜0.01),(2)Prolonged QT interval in patients with end-stage liver disease before OLT(x2 =11.00,P＜0.01).Conclusions Cardiac arrhythmia was common complication after OLT,and it can lead to death of recipients.Careful evaluation to recipients before OLT,controlling fluid load after OLT,keeping the balance of the electrolyte,acidity and alkalescence,giving intensive monitor to patients with heart disease before OLT and prolonged QT interval are the key factor to reduce incidence and mortality of cardiac arrhythmia.Application of medication and cardiac pacemaker can prevent cardiovascular accident after OLT. Key words: Liver transplantation; Arrhythmia; Causality

Despite advances in catheter ablation techniques and device-based therapies for cardiac arrhythmias, antiarrhythmic drugs remain essential components of any comprehensive therapeutic strategy. Antiarrhythmic drug therapy, however, has been limited by both incomplete efficacy and a substantial potential for cardiac and extracardiac toxicity. As a result, only a few new antiarrhythmic agents have successfully completed clinical development programs and reached routine clinical usage over the past 20 years. Antiarrhythmic drugs may be indicated for ventricular tachycardia, sudden death prevention, or specific types of supraventricular arrhythmia. Implantable cardioverter-defibrillator (ICD) therapy has evolved as the primary treatment for most life-threatening ventricular arrhythmias, and antiarrhythmic drugs for these rhythms are currently mostly used either as acute interventions or as adjuncts to chronic ICD therapy. Although numerous trials have evaluated the effect of antiarrhythmic drugs to decrease ICD shocks or therapies, such data have yet to provide the sole basis for approval for any new agent. At the same time, drug therapy for atrial arrhythmias is often limited by the drug’s simultaneous effects on the ventricles, which has led to efforts to identify ionic channel targets specific to or preferentially located in the atria. The sustained outward K+ current (IKur, encoded by the Kv 1.5 subunit), the acetylcholine-activated outward K+ current (IKAch), and both peak and late atrial Na+ currents have therefore become potential targets for antiarrhythmic drug developers.1–4 Another approach has been to seek agents that synergistically affect multiple channels simultaneously, resulting in a net beneficial effect while minimizing toxicity. Other nontraditional targets for drug therapy that do not directly involve ion channels have also emerged as our understanding of the mechanisms of arrhythmias has improved. As a result, several new compounds are now at or near completion of phase 3 clinical trials, and other promising …

Background: Arrhythmias are relatively common in patients with non-ischemic cardiomyopathies. There are limited data on the association of atrial and ventricular arrhythmias with outcomes in patients with peripartum cardiomyopathy (PPCM). Methods: We queried the 2003-2011 Nationwide Inpatient Sample databases using the ICD-9 diagnostic codes 674.50 to 674.55, to identify all women aged between 15-55 years admitted with a diagnosis of PPCM. The various arrhythmias were identified using appropriate ICD-9 diagnostic codes - atrial fibrillation (AF) (427.31), atrial flutter (427.32), supraventricular tachycardia (SVT) (427.0), ventricular tachycardia (VT) (427.1), ventricular fibrillation (VF) (427.41 and 427.42). Multivariable adjusted logistic regression was used to study the association of arrhythmias with in-hospital mortality and multivariable adjusted linear regression was used to study the association of arrhythmias with length of stay and hospital charges. Results: From 2003 to 2011, 34,944 patients were hospitalized with PPCM. The mean age was 30±7 years. Among these patients with PPCM, ventricular tachycardia (VT) (4.8%) was the most common arrhythmia followed by atrial fibrillation (AF) (2.2%), ventricular fibrillation (VF) (1.3%), atrial flutter (0.8%) and supraventricular tachycardia (SVT) (0.6%). The risk adjusted in-hospital mortality was higher in PPCM patients with AF (3.6% vs 1.2%, adjusted OR 2.38, 95% CI 1.50-3.78), VT (3.7% vs 1.1%, adjusted OR 1.8, 95% CI 1.30-2.48) and VF (14.2% vs 1.1%, adjusted OR 5.39, 95% CI 3.75-7.74) compared to those without arrhythmias. Among the study population, the average length of stay was longer in patients with AF (8 vs 5 days, p&lt;0.001), atrial flutter (10 vs 5 days, p&lt;0.001), SVT (10 vs 5 days, p&lt;0.001), VT (9 vs 5 days, p&lt;0.001) and VF (10 vs 5 days, p&lt;0.001). The average hospital charges was also higher in patients with AF ($74,799 vs $40,974; p=0.004), atrial flutter ($129,692 vs $41,042; p&lt;0.001), SVT ($133,223 vs $41,165; p&lt;0.001), VT ($97,525 vs $38,929; p&lt;0.001) and VF ($158,381 vs $40,194; p&lt;0.001). Conclusions: In patients hospitalized with PPCM AF, VT and VF were independently associated with significantly higher in-hospital mortality. Also in these patients AF, atrial flutter, SVT, VT and VF were independently associated with higher hospital charges and longer length of stay.

Cardiac Arrhythmias in Obstructive Sleep Apnea (from the Akershus Sleep Apnea Project)

Antiarrhythmic drugs and anaesthesia: part 1. mechanisms of cardiac arrhythmias

Excerpt This study will consider the hemodynamic disturbances of the coronary flow which occur during cardiac arrhythmias. It has been shown that fast cardiac arrhythmias can precipitate severe dis...

Abstract. Alprenolol, a beta‐receptor blocking agent with a slight intrinsic beta‐receptor stimulating effect, has been given to 15 acute coronary patients intravenously for treatment of acute arrhythmias. The results were successful in one case out of three with atrial fibrillation, in none of the three cases with ventricular tachycardia, in three cases out of four with supraventricular tachycardia, in three cases out of four with ventricular ectopic beats, and unsuccessful in the only atrial flutter case. In four cases the injection of 2.5–5.0 mg of alprenolol resulted in sudden circulatory collapse and clinical shock. In all these cases the blood pressure was readily restored with metaraminol or noradrenaline infusion without complications. It is evident that the beta‐receptor stimulating effect is not sufficient to compensate the drawbacks of beta‐blockade in this drug. Alprenolol cannot be recommended in the treatment of arrhythmias in acute coronary patients.

AHA/ACCF Scientific Statement on the Evaluation of Syncope