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Beta blockers have limited efficacy in idiopathic ventricular premature
Beta blockers have limited efficacy in idiopathic ventricular premature. Recently, the Journal of Cardiovascular Electrophysiology published such a study.
The study included 120 patients with premature ventricular load ≥ 5% and no organic heart disease on ultrasonography. The average age is 56.5 ± 14.6 years, and 54.2% are women.
Among them, 53 patients were treated with β-blockers or calcium channel blockers (BBs/CCBs), 27 patients were treated with Class I or Class III antiarrhythmic drugs (AADs), and 40 patients were treated conservatively.
The patient’s initial premature ventricular load ranged from 15.5% to 20.6%.
In the conservative treatment, BBs/CCBs, and AADs cohorts, there was an average reduction of 32.7%, 30.5%, and 81.3% in the room early. The proportion of early room load falling to <1% was 35.0%, 17.0%, and 33.3% in each group.
Compared with BBs/CCBs, AADs (p = 0.017) and conservative treatment (p = 0.045) reduced the number of premature rooms.
Four patients (4/120, 3.3%) developed left ventricular dysfunction. The adverse drug reactions and drug withdrawal rates were similar among the groups, and no serious adverse events were found.
This study verified two things. First, can beta blockers reduce the frequency of idiopathic ventricular premature? The second is how much left ventricular heart function will be affected in idiopathic ventricle?
At present, β-blockers are the first choice for the treatment of idiopathic ventricular premature, but we have also found clinically that β-blockers have limited effects in reducing ventricular premature, and only those effects related to exercise and stress are still acceptable. .
It is the class I and class III antiarrhythmic drugs that can significantly reduce ventricular premature, but they have achieved complete suppression in only one-third of patients.
Why can the ventricle be reduced in patients who do not use the conservative treatment of β-blockers and class I and III antiarrhythmic drugs?
In fact, during the follow-up, about 40% of the room load will decrease by itself. Let’s look at another study published in “Heart”.
The study followed up 100 patients with idiopathic ventricular premature, with an average ventricular premature load of 18.4%, no organic heart disease, no radiofrequency ablation and use of antiarrhythmic drugs. The average age is 51.8 years and 57% are women. The average follow-up was 15.4 months.
In 44 cases (44.0%), the room load was reduced to <1%, of which only 4 cases (4/44, 9.1%) had an increase in room early.
Four patients (4.3%) with persistently elevated ventricular premature load developed left ventricular insufficiency (LVEF <50%) during the 53-71 months follow-up period.
It can be seen that it is not possible to assess the early prognosis of the idiopathic room and immediately formulate treatment strategies based on the first (or one) Holter electrocardiogram alone.
In fact, the total load of the room morning cannot be accurately estimated with a 24-hour Holter. We will meet some patients, this time there are 20,000 premature beats on the Holter, and the next time there may be only 5,000.
Some studies also believe that to accurately assess the room’s early load, it is necessary to continuously monitor for 7 days. Therefore, the study believes that the self-improvement does not rule out the variation of the early load of the room.
(source:internet, reference only)