Oral Beta-blockers Research Articles

GW24-e3749 Presentation, Treatment and Prognosis of Acute Heart Failure in the Emergency Department: A Prospective, Cohort, Multicentre, Non-interventional Registry Study

ObjectivesThe purpose of this study was to assess the clinical characteristics, treatments, and prognosis of acute heart failure (AHF) in the emergency department.MethodsA prospective, cohort, multicentre, non-interventional registry study of...

Safe Nurse-Led Pre-CTCA Beta-Blockade Administration can be Achieved Without Intensive Medical Supervision

Adjustments to the standard oral Beta Blocker protocol always reect a reduction in the dosage. Protocol deviation is often used in patients where there is either not enough time from preparation to scanning time for the oral BB to take effect or in patients where we are cautious of excessive BB effects for a clinical reason. In these cases it is understandable that the use of IV BB is increased as the onset is quick and the half life is minutes rather than hours. Best care for everyone Jo.wickham@waitematadhb.govt.nz This table shows the standard oral BB dosage protocol (per heart rate in beats per minute) versus the actual dosage given. Highlighted boxes indicate where the standard protocol dose was administered. Nurse specialists play an important role in the delivery of CT coronary angiography (CTCA) in the acute chest pain setting. The appropriate dosing of oral and intravenous beta-blockers is crucial to achieve the required heart rate at time of scan of 60 bpm or less. A beta blocker dosing protocol was developed at North Shore Hospital as a guideline for prescription. Nurse specialists worked with the developed dosing protocol over 18 months and found that it was necessary, at times, to deviate from the protocol due to patient history, timing of the scan or ECG information to achieve a safe and effective scan.

Radiofrequency Catheter Ablation of Intractable Ventricular Tachycardia in an Infant Following Arterial Switch Operation

A full-term male neonate presented with cyanosis upon delivery and was subsequently diagnosed with d-transposition of the great arteries, ventricular septal defect, and restrictive atrial septal defect. Following initiation of intravenous prostaglandins and balloon atrial septostomy, an arterial switch operation was performed on day 3 of life. The postoperative course was complicated by intractable ventricular tachycardia that was refractory to lidocaine, amiodarone, esmolol, fosphenytoin, and mexiletine drug therapy. Ventricular tachycardia was suppressed with overdrive atrial pacing but recurred upon discontinuation. Seven weeks postoperatively, radiofrequency catheter ablation was performed due to hemodynamically compromising persistent ventricular tachycardia refractory to medical therapy. The ventricular tachycardia was localized to the inferior-lateral right ventricular outlet septum. The procedure was successful without complications or recurrence. Antiarrhythmics were discontinued after the ablation procedure. Seven days after the ablation, a different, slower fascicular rhythm was noted to compete with the infant's sinus rhythm. This was consistent with the preablation amiodarone having reached subtherapeutic levels given its very long half-life. The patient was restarted on oral beta blockers and amiodarone. The patient was subsequently discharged home in predominantly sinus rhythm with intermittent fascicular rhythm.

Effect of landiolol hydrochloride after off-pump coronary artery bypass

many studies have shown that oral beta blockers reduce the incidence of atrial fibrillation after coronary artery bypass. The goal of this study was to determine whether landiolol, an intravenous beta blocker, reduces the incidence of atrial fibrillation after off-pump coronary artery bypass. 39 consecutive patients were given landiolol after coronary artery bypass, and 20 who were not given landiolol served as a control group. Landiolol was intravenously administered at 1 µg.kg(-1).min(-1) in the intensive care unit. the mean dose of landiolol was 2.3 ± 1.2 1 µg.kg(-1).min(-1). The incidence of atrial fibrillation during intensive care unit stay was significantly lower in the landiolol group compared to the control group: 2.6% (1/39) vs. 20% (4/20). Heart rate after landiolol administration was significantly lower than that before administration, whereas landiolol had no effect on blood pressure. C-reactive protein and creatine kinase levels 7 days after surgery were significantly lower in the landiolol group. continuous administration of landiolol at a low dose after off-pump coronary artery bypass reduced the incidence of atrial fibrillation.

Management of Patients With Atrial Fibrillation (Compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS Recommendations)

This document is a compilation of the current American College of Cardiology Foundation/American Heart Association (ACCF/AHA) practice guideline recommendations for atrial fibrillation (AF) from the “ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation),”* the “2011 ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Updating the 2006 Guideline)”† and the “2011 ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Update on Dabigatran).”‡ Updated and new recommendations from 2011 are noted and outdated recommendations have been removed. No new evidence was reviewed, and no recommendations included herein are original to this document. The ACCF/AHA Task Force on Practice Guidelines chooses to republish the recommendations in this format to provide the complete set of practice guideline recommendations in a single resource. ### 1.1. Pharmacological and Nonpharmacological Therapeutic Options #### 1.1.1. Rate Control During AF Class I 1. Measurement of the heart rate at rest and control of the rate using …

Beta-blockers for the treatment of problematic hemangiomas

To examine treatment indications, efficacy and side effects of oral beta-blockers for the treatment of problematic hemangiomas. A retrospective review of patients with hemangiomas presenting to the Alberta Children's Hospital Vascular Birthmark Clinic (Calgary, Alberta) between 2009 and 2011 was conducted. The subset of patients treated with oral beta-blockers was further characterized, investigating indication for treatment, response to treatment, time to resolution of indication, duration of treatment, occurrence of rebound growth and side effects of therapy. Between 2009 and 2011, 311 new patients with hemangiomas were seen, of whom 105 were treated with oral beta-blockers. Forty-five patients completed beta-blocker treatment while the remainder continue to receive therapy. Indications for treatment were either functional concerns (68.6%) or disfigurement (31.4%). Functional concerns included ulceration (29.5%), periocular location with potential for visual interference (28.6%), airway interference (4.8%), PHACES syndrome (3.8%), auditory interference (0.95%) and visceral location with congestive heart failure (0.95%). The median age at beta-blocker initiation was 3.3 months; median duration of therapy was 10.6 months; and median maximal treatment dose was 1.5 mg/kg/day for propranolol and 1.6 mg/kg/day for atenolol. Ninety-nine patients (94.3%) responded to therapy with size reduction, colour changes, softened texture and/or healing of ulceration. Rebound growth requiring an additional course of therapy was observed in 23 patients. Side effects from beta-blockers included cool extremities (26.7%), irritability (17.1%), lower gastrointestinal upset (14.3%), emesis (11.4%), hypotension (10.5%), poor feeding (7.6%), lethargy (4.8%), bronchospasm (0.95%) and rash (0.95%). Side effects did not result in complete discontinuation of beta-blocker treatment in any case; however, they prompted a switch to a different beta-blocker preparation in some cases. Resolution of the primary indication, requiring a median time of three months, occurred in 87 individuals (82.9%). Treatment of infantile hemangiomas with oral beta-blocker therapy is highly effective and well tolerated, with more than 94% of patients demonstrating a response to treatment and 90% showing resolution of the primary functional indication for treatment.

Myocardial protection with prophylactic oral metoprolol during coronary artery bypass grafting surgery: evaluation by troponin I

IntroductionBiochemical markers of myocardial injury are frequently altered after cardiac surgery. So far there is no evidence whether oral beta-blockers may reduce myocardial injury after coronary artery bypass grafting. ObjectiveTo determine if oral administration of prophylactic metoprolol reduces the release of cardiac troponin I in isolated coronary artery bypass grafting, not complicated by new Q waves. MethodsA prospective randomized study, including 68 patients, divided in 2 groups: Group A (n=33, control) and B (n=35, beta-blockers). In group B, metoprolol tartrate was administered 200 mg/day. The myocardial injury was assessed by troponin I with 1 hour and 12 hours after coronary artery bypass grafting. ResultsNo significant difference between groups regarding pre-surgical, surgical, complication in intensive care (15% versus 14%, P=0.92) and the total number of hospital events (21% versus 14%, P=0.45) was observed. The median value of troponin I with 12 hours in the study population was 3.3 ng/ml and was lower in group B than in group A (2.5 ng/ml versus 3.7 ng/ml, P<0,05). In the multivariate analysis, the variables that have shown to be independent predictors of troponin I release after 12 hours were: no beta-blockers administration and number of vessels treated. ConclusionThe results of this study in uncomplicated coronary artery bypass grafting, comparing the postoperative release of troponin I at 12 hours between the control group and who used oral prophylactic metoprolol for at least 72 hours, allow to conclude that there was less myocardial injury in the betablocker group, giving some degree of myocardial protection.

Safe Nurse-led Pre-CTCA Beta-blockade Administration Can Be Achieved Without Intensive Medical Supervision

Background: Nurse specialists play an important role in the delivery of CT coronary angiography (CTCA) in the acute chest pain setting. The appropriate dosing of oral and intravenous beta-blockers is crucial. Methods: We prospectively collected data from August 2011 to February 2013 on the use of beta-blockade in patient preparation for CTCA. In our institution, nurse specialists with coronary care unit background administer beta-blockers without immediate hands-on medical supervision. A dosing protocol guides the administration of up to 150 mg oral Metoprolol according to baseline heart rate, but can be varied depending on patient status. Up to 30 mg intravenous Metoprolol is administered at the time of scanning should heart rate control be inadequate. Results: Of the 1104 patients prepared for CTCA, 35 patients (3%) did not proceed due to inadequate heart rate control. The analysis excluded 108 patients on regular beta-blocker and 16 patients who had calcium channel blocker for heart rate control. Protocol adjustments occurred in half the patients, with a lowered Metoprolol dose given in 388 patients (41%). Subsequent IV Metoprolol is more frequent, compared to those given the suggested dosage, (41% vs. 30%, p = 0.0074). Safety is excellent, with rare complications: mild dizziness (1%), hypotension (2%, only one case was symptomatic). Conclusion: Safe pre-CTCA beta-blockade relies heavily on sound clinical judgment of experienced nurse specialists in adjusting the protocol-suggested dosage according to clinical status, but can be achieved without intensive medical supervision.

Dose‐dependent Effect of Statin Therapy on Circulating CXCL12 Levels in Patients with Hyperlipidemia

BackgroundHMG-CoA reductase inhibitors (statins) have pleiotropic effects that are independent of cholesterol-lowering, including a dose-dependent effect on angiogenesis. Angiogenesis plays a critical role both in vascularization of the chronically ischemic myocardium and in stabilization of atherosclerotic plaques. Chemokines, a family of structurally-related cytokine molecules, exert diverse biological functions including control of angiogenesis. The effect of statin therapy on angiogenic and angiostatic chemokines has not been evaluated extensively. We sought to test the hypothesis that, in subjects with hyperlipidemia, statin therapy influences plasma levels of angiogenic and angiostatic chemokines in a dose-dependent manner.MethodsWe prospectively collected demographic, angiographic and laboratory data from subjects with a history of hyperlipidemia who were either untreated or on statin therapy. A peripheral blood sample was obtained for measurement of plasma angiogenic and angiostatic chemokines. Multivariable analysis using logistic regression was performed adjusting for the following variables: age, gender, prior myocardial infarction, and chronic administration of aspirin, clopidogrel, insulin, oral hypoglycemic agents, beta-blockers and calcium channel blockers.Results168 patients on statin therapy (48 on low-dose, defined as <10mg atorvastatin-equivalent, and 120 on high-dose, defined as ≥10mg atorvastatin-equivalent dose) and 11 subjects from the same database who had a history of hyperlipidemia but who were not on statins were enrolled. There were no significant differences in baseline demographics, co-morbidities, lipid panels, other medications, or angiographic data between the groups. The angiogenic chemokines CXCL1 and CXCL12 levels were significantly different across the groups. Median levels of CXCL1 were highest in subjects not on statin therapy. Compared to subjects either not on statin therapy or on low-dose statins, those taking high-dose statins had lower median values of CXCL12 (2316 [2255–11071], vs 2362 [2016–10622], vs 2189 [1968–2705] pg/mL, p=0.042). On multivariate analysis, CXCL12 remained the only factor that was strongly and inversely associated with statin dose at the 95% level (p=0.011).ConclusionsCompared to no therapy or low-dose statin therapy, treatment with high-doses of HMG-CoA reductase inhibitors is associated with decreased circulating CXCL12 levels in subjects with hyperlipidemia, and CXCL12 is strongly and inversely associated with statin dose. Additional studies are needed to confirm this finding in other cohorts and to determine if high-dose statins affect angiogenesis in patients.

Rubeotic glaucoma and what else should be worried about?

A 88 year old man presented to eye casualty with increasing pain in the right eye (RE) over the last week followed by popping sensation, discharge and easing pain. He was blind in the RE due to previous centralretinal-vein-occlusion. The RE also had rubeotic glaucoma with mean intraocular pressure of 30 mmHg. This was being treated with oral acetazolamide, topical beta-blocker (0.5 % Timolol) and topical steroid for 10 years. He had a previous uncomplicated extra-capsular-cataract-extraction and a one piece rigid polymethylmethacrylate (PMMA) intraocular lens was inserted in this eye. His left eye was eviscerated secondary to painful blind eye 13 years ago. On examination erythema of the lids were noted. The conjunctiva was chemotic and haemorrhagic with extrusion of uveal content from a dehiscence extending from the superior/limbal sclera which appeared to be necrotic (Fig. 1). Evisceration was performed as an emergency procedure. Pathological examination revealed severe, focal neutrophil infiltration of the conjunctiva, uvea and sclera with signs of necrosis (Fig. 2) suggesting high possibility of spontaneous globe rupture secondary to suppurative sclerokeratitis associated with bullous keratopathy.

Efficacy and Safety of Intravenous Esmolol to Control Heart Rate Prior to 320-Slice Computed Tomography Coronary Angiography

Background: Image quality in computed tomography coronary angiography (CTCA) is highly dependent on heart rate (HR). Intravenous metoprolol is widely used as an adjunct to oral beta-blockers. The short-acting parenteral beta-blocker esmolol is rapidly inactivated by circulating plasma esterases and may be a preferable agent to use in this setting. Methods: Eighty-three consecutive patients referred for inpatient CTCA from November 2011 to March 2012 were loaded with 50–200 mg of oral metoprolol at least 2 h prior to being scanned, if their resting HR was >60. Patients who still had a HR > 60 on the scanner table were given intravenous esmolol in boluses of 40–60 mg up to a maximum of 150 mg under the supervision of a medical officer. Continuous cardiac monitoring was used from the commencement of oral metoprolol loading, up until 1 h following scanning. Results: Seventy-four patients (89.2%) received metoprolol at a mean dose of 110.5 mg. Twenty-seven patients (32.5%) received intravenous esmolol at a mean dose of 68.5 mg. Mean HR at image acquisition was 58.6 beats per minute. No adverse events or significant bradyarrhythmias were recorded. Discussion: The half-life of metoprolol is 3–7 h, compared to 9 min with esmolol. In this small non-randomised study, the use of oral metoprolol with adjunctive intravenous esmolol was safe, well-tolerated and efficacious. Adjunctive esmolol may be particularly well-suited to the outpatient setting, where patients are discharged soon after being scanned, but further study is needed.

Effects of preoperative oral beta blocker versus intraoperative nitroprusside or esmolol on quality of surgical field during tympanoplasty

Study Objective To determine whether orally administered atenolol provides an optimal surgical field in comparison to intravenous sodium nitroprusside or esmolol during tympanoplasty. Design Randomized, double-blinded study. Setting Operating room in a university hospital. Patients 105 ASA physical status 1 and 2 adult patients undergoing tympanoplasty. Interventions Patients were randomized to three groups to receive either oral atenolol 50 mg twice daily for one day prior to surgery (Group I), intraoperative nitroprusside infusion (Group II), or intraoperative esmolol infusion (Group III). Measurements Quality of the operative field, mean arterial pressure, and heart rate were assessed. Blood gases, liver enzymes, cardiac troponin I, creatine kinase isoenzyme-MB release, blood urea nitrogen, and creatinine concentrations also were measured. Main Results Time to achieve target surgical field was significantly reduced in the atenolol group versus the other groups (8.3 ± 3.2, 28.2 ± 6.4, and 17.2 ± 5.3 min, respectively). Heart rate significantly decreased in the atenolol and esmolol groups versus the nitroprusside group ( P < 0.0001). Mean arterial pressure after extubation and frequency of rebound hypertension were comparable in the groups. No significant changes in cardiac enzymes, renal and hepatic function, or acid-base status were noted. Conclusions Although the three drugs are acceptable for obtaining an optimum surgical field, preoperative oral beta blocker appeared to be rapid in onset and was simpler to implement.

Isolated Junctional Tachycardia in a Child After Noncardiac Surgery: An Uncommon Clinical Presentation

Isolated junctional tachycardia is rare in children but has been reported after cardiac surgery. To date, it has not been reported after noncardiac surgery. This report describes the case of a 3-year-old boy with no cardiac history who experienced transient junctional tachycardia after a right pyeloplasty. Medical therapy was not prescribed initially due to lack of symptoms. However, symptomatic junctional tachycardia recurred, prompting institution of oral beta-blocker therapy. Isolated junctional tachycardia should not be overlooked in the differential diagnosis of pediatric supraventricular tachycardia after noncardiac surgery.

Exercise-Induced Right Ventricular Outflow Tract Tachycardia in a Patient with Isolated Left Ventricular Noncompaction

Isolated left ventricular noncompaction is a hereditary cardiomyopathy in which a variety of supraventricular and ventricular arrhythmias could be observed. We report a patient with exercise-induced ventricular tachycardia with left bundle branch block morphology that had characteristics of an idiopathic ventricular tachycardia who was subsequently diagnosed as left ventricular noncompaction. Successful remission of arrhythmia was ensured after the introduction of oral beta-blocker therapy.

P040 Effect on Heart Rate Reduction of Prolonged Apnea Technique in Coronary CTA with a 320-Detector-Row Scanner

Objective: To evaluate the effectiveness of prolonged apnea technique in lowering heart rate for coronary CTA performed with a 320-detector-row scanner. Methods: With background history of chest pain or positive treadmill results, a total of 307 patients for coronary CTA between March and June 2010 were included retrospectively. The patients’ heart rates (HRs) were sampled at three different timings: upon their arrival at our unit, pre-imaging after oral beta-blocker intake and at the time when coronary CTA acquisition began after prolonged apnea. The patients were then divided into two groups: Group A with baseline HR>65bpm and were put on oral beta-blocker according to our protocol before scanning, whereas Group B with baseline HR<65bpm and acted as control without oral intake of beta-blocker. Prolonged Apnea Scanning Protocol was used, as the patients were instructed to hold breath at 75% maximum lung capacity about 10–12 s after iv contrast injection, and manual triggering of the coronary CTA acquisition was made when the optimal contrast enhancement was seen on descending aorta with the lowest HR reduction or with the lowest HR below target achieved. Results: The mean breath-hold time was 11.5 s (SD 4.5 s) and the mean delay time was 23.5 s (SD 4.5 s). In Group A (n =208) with baseline heart rate more than 65bpm, the mean HR at arrival was 77.995bpm, at pre-imaging after oral beta-blocker was 64.928bpm and at CTA with prolonged apnea technique was 58.144bpm. About 84% of the patients showed reduction in HR, and the mean reduction of HR was 19.85bpm (p=0.0001). In Group B (n =99) with baseline heart rate less than 65bpm, the mean HR at arrival was 57.91 bpm and at CTA with prolonged apnea technique was 55.33bpm. About 66% of the patients showed reduction in HR, and the mean reduction of HR was 2.58 bpm (p=0.0036). Conclusion: In coronary CTA with a 320-detector-row CT scanner, prolonged apnea technique with 11.5 s during CCTA acquisition is an efficient mean in significantly lowering patients’ heart rate during the procedure. This technique is not only easy and safe to perform, but also allows wide range of HR selection and optimizes contrast enhancement, which will eventually leads to reduction in radiation dose and improvement in image quality.

¿Betabloqueante oral o intravenoso en coronariografía mediante tomografía computarizada? Un estudio prospectivo y aleatorizado

Objectives To determine whether the time employed in the radiological management of outpatients undergoing computed tomography (CT) coronary angiography varies in function of whether oral or intravenous beta-blockers are administered. Material and methods This was a prospective, analytical, randomized controlled trial. A total of 40 patients with heart rates greater than 65 beats per minute were randomly assigned to one of two groups. Patients in group 1 were administered oral beta-blockers and patients in group 2 were administered intravenous beta-blockers. We measured the overall time from entry to the radiology department to exit from the CT examination room. We also measured heart rate, blood pressure, and the number of conclusive studies. Results The median (interquartile range) overall time was 120 (100-150) minutes in the 19 patients who received oral beta-blockers compared to 35 (27.5-67.5) minutes in the 21 patients who received intravenous beta-blockers (p < 0.001). The median time that patients were in the CT examination room was 10 (6-15) minutes in Group 1 and 10 (9-20) minutes in Group 2 (p = 0.57). The decrease in mean arterial pressure was 10 mmHg after the administration of intravenous beta-blockers compared to 3.3 mmHg after the administration of oral beta-blockers (p = 0.01). No significant differences were found in the diagnostic quality of the examinations. Conclusions The time employed in the radiological management of patients undergoing CT coronary angiography is significantly lower when beta-blockers are administered intravenously. There was no difference in the time patients were in the CT examination room or in the diagnostic quality of the examinations.

Oral versus intravenous beta-blockers for computed tomography coronary angiography? A randomized controlled trial

ObjectivesTo determine whether the time employed in the radiological management of outpatients undergoing computed tomography (CT) coronary angiography varies in function of whether oral or intravenous beta-blockers are administered. Material and methodsThis was a prospective, analytical, randomized controlled trial. A total of 40 patients with heart rates greater than 65 beats per minute were randomly assigned to one of two groups. Patients in group 1 were administered oral beta-blockers and patients in group 2 were administered intravenous beta-blockers. We measured the overall time from entry to the radiology department to exit from the CT examination room. We also measured heart rate, blood pressure, and the number of conclusive studies. ResultsThe median (interquartile range) overall time was 120 (100–150) minutes in the 19 patients who received oral beta-blockers compared to 35 (27.5–67.5) minutes in the 21 patients who received intravenous beta-blockers (p < 0.001). The median time that patients were in the CT examination room was 10 (6–15) minutes in Group 1 and 10 (9–20) minutes in Group 2 (p=0.57). The decrease in mean arterial pressure was 10mmHg after the administration of intravenous beta-blockers compared to 3.3mmHg after the administration of oral beta-blockers (p=0.01). No significant differences were found in the diagnostic quality of the examinations. ConclusionsThe time employed in the radiological management of patients undergoing CT coronary angiography is significantly lower when beta-blockers are administered intravenously. There was no difference in the time patients were in the CT examination room or in the diagnostic quality of the examinations.

Current drug therapies for infantile hemangioma: focused on beta blocker

I hemangioma (IH), a common vascular tumor from vascular birth marks, used to be untreated due to its natural course of spontaneous regression with few exceptions like cosmetic disfigurement, functional or life impairment. It has been treated through a variety of methods like the topical and systemic corticosteroid, surgery, laser, etc. Among them, systemic corticosteroid, which has been used most commonly, may sometimes cause troublesome side effects such as temporary growth retardation or personality change, so it is often clinically inapplicable. Recently, however, it was reported that treatment using beta blocker for IH is more effective with fewer side effects than conventional treatments. Oral beta blocker has been used for IH patients who concerns about presenting ulcerative lesions, impending cosmetic sequelae or functional and life impairment. Before the administration of beta blocker, the patient goes through inquiry about clinical history, physical examination, electrocardiogram and echocardiography in order to determine the applicability. During the hospital stay, vital signs and blood glucose level are checked regularly to rule out side effects of beta blocker, and the dosage is increased gradually up to 2 mg/kg/day and the same dose is maintained continuously after discharge with same dosage. After considering many previous studies about beta blocker for IH patients, we reached an interim conclusion. The treatment of IH using beta blocker is effective, highly satisfactory and safe with no side effects though the selection from various beta blockers, evaluation methods of therapeutic efficacy and its duration and end point of treatment need to be confirmed.

High Incidence of Inappropriate ICD Therapies in Young Patients with Catecholaminergic Polymorphic Ventricular Tachycardia

Introduction: We present three young patients with inappropriate shocks of implantable cardioverter defibrillator (ICD) therapies that were performed for the treatment of ventricular arrhythmias due to catecholaminergic polymorphic ventricular tachycardia (CPVT). Case Presentations: Case 1: a 4 year-old boy, CPVT with syncope occurred during swimming. He was treated with an ICD because he complained of syncope repeatedly and administered oral beta-blocker. During follow-up, he had inappropriate shocks due to rapid paroxysmal atrial fibrillation (PAF) during exercise. The PAF was disappeared with an additional flecainide, oral antiarrhythmic agent. Case 2: a 16 year-old boy, CPVT resulting in cardiopulmonary arrest occurred during exercise. He was treated with an ICD and prescribed oral beta-blocker. After that, inappropriate shocks were delivered under his awareness due to the occurrence of rapid PAF. With additional administration of flecainide, inappropriate shocks were decreased. Case 3: a 21 year-old man, an ICD was implanted for CPVT with syncope. He had repeatedly inappropriate shocks due to the occurrence of atrial flutter (AFL). Catheter ablation were performed for eliminating his AFL. Conclusions: In young patients with CPVT, inappropriate ICD therapies easily occur with atrial tachyarrhythmias even if a dual chamber ICD was used. An additional antiarrhythmic drug therapy or catheter ablation should be considered to inhibit such an inappropriate shock.

Lack of Effect of Oral Beta-Blocker Therapy at Discharge on Long-Term Clinical Outcomes of ST-Segment Elevation Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention

Lack of Effect of Oral Beta-Blocker Therapy at Discharge on Long-Term Clinical Outcomes of ST-Segment Elevation Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention