Beta-blocker therapy is associated with a lower incidence of syncope due to fast ventricular tachycardias among implantable cardioverter-defibrillator patients with left ventricular dysfunction: results from a multicenter study

Abstract

Among implantable cardioverter-defibrillator (ICD) patients, a substantial proportion of syncopes are due to fast ventricular tachycardias (FVTs). In the experimental models of ventricular tachycardias, the arterial vasoconstriction plays an important role in recovering the arterial pressure. Since beta-blockers increase vascular resistance, we hypothesized that beta-blockers could reduce the occurrence of syncope due to FVTs. Our objective was to determine the relationship between the beta-blocker therapy and the incidence of syncope in FVT (cycle length [CL] 250-320ms) occurring in ICD patients. Slow VTs were excluded because of the lack of symptoms and VF episodes because of the small number. In this multicenter study, 226 patients (LVEF 31 ± 10%) with single-chamber ICDs were followed. FVT programming was standardized, including antitachycardia pacing (ATP) as initial therapy. Symptoms were correlated with ICD-stored episode data of FVTs. The beta-blocker therapy was determined at each FVT presentation. We analyzed 289 FVTs (CL 291 ± 21ms; 77% under beta-blockers; median of the duration:8s) occurring consecutively in 52 ICD patients. The frequency of FVT-related syncope was 22 (7.6%). Beta-blockers were associated with a lower heart rate preceding FVT (85 ± 22 vs. 94 ± 23bpm; p = 0.009), a higher ATP effectiveness (86 vs. 57%; p < 0.001), a lower duration of episodes (8 [2] vs. 10 [14]s; p < 0.001), and a lower incidence of FVT-related syncope (4.5 vs. 18%; p < 0.001). By logistic regression, a FVT > 8s (OR = 21; p = 0.003) and the beta-blocker therapy (OR = 0.3; p = 0.012) were found as independent predictors of syncope. Among ICD patients with left ventricular dysfunction, beta-blockers are associated with a lower incidence of FVT-related syncope.