Not all beta-blockers are equal in the management of Long QT Syndrome types 1 and 2: higher recurrence of events under metoprolol

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Fältnamn	Indikatorer	Metadata
000		04244naa a2200565 4500
001		oai:DiVA.org:umu-62152
003		SwePub
008		121210s2012 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-621522 URI
024	7	a https://doi.org/10.1016/j.jacc.2012.07.0462 DOI
040		a (SwePub)umu
041		a engb eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Chockalingam, Priya4 aut
245	1 0	a Not all beta-blockers are equal in the management of Long QT Syndrome types 1 and 2 :b higher recurrence of events under metoprolol
264	1	b Elsevier BV,c 2012
338		a print2 rdacarrier
520		a Objectives The purpose of this study was to compare the efficacy of beta-blockers in congenital long QT syndrome (LQTS). Background Beta-blockers are the mainstay in managing LQTS. Studies comparing the efficacy of commonly used beta-blockers are lacking, and clinicians generally assume they are equally effective.Methods Electrocardiographic and clinical parameters of 382 LQT1/LQT2 patients initiated on propranolol (n = 134), metoprolol (n = 147), and nadolol (n = 101) were analyzed, excluding patients <1 year of age at beta-blocker initiation. Symptoms before therapy and the first breakthrough cardiac events (BCEs) were documented.Results Patients (56% female, 27% symptomatic, heart rate 76 +/- 16 beats/min, QTc 472 +/- 46 ms) were started on beta-blocker therapy at a median age of 14 years (interquartile range: 8 to 32 years). The QTc shortening with propranolol was significantly greater than with other beta-blockers in the total cohort and in the subset with QTc >480 ms. None of the asymptomatic patients had BCEs. Among symptomatic patients (n = 101), 15 had BCEs (all syncopes). The QTc shortening was significantly less pronounced among patients with BCEs. There was a greater risk of BCEs for symptomatic patients initiated on metoprolol compared to users of the other 2 beta-blockers combined, after adjustment for genotype (odds ratio: 3.95, 95% confidence interval: 1.2 to 13.1, p = 0.025). Kaplan-Meier analysis showed a significantly lower event-free survival for symptomatic patients receiving metoprolol compared to propranolol/nadolol.Conclusions Propranolol has a significantly better QTc shortening effect compared to metoprolol and nadolol, especially in patients with prolonged QTc. Propranolol and nadolol are equally effective, whereas symptomatic patients started on metoprolol are at a significantly higher risk for BCEs. Metoprolol should not be used for symptomatic LQT1 and LQT2 patients.(J Am Coll Cardiol 2012;60:2092-9) (C) 2012 by the American College of Cardiology Foundation
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kardiologi0 (SwePub)302062 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Cardiac and Cardiovascular Systems0 (SwePub)302062 hsv//eng
653		a breakthrough cardiac events
653		a congenital long QT syndrome
653		a metoprolol
653		a nadolol
653		a propranolol
700	1	a Crotti, Lia4 aut
700	1	a Girardengo, Giulia4 aut
700	1	a Johnson, Jonathan N4 aut
700	1	a Harris, Katy M4 aut
700	1	a van der Heijden, Jeroen F4 aut
700	1	a Hauer, Richard NW4 aut
700	1	a Beckmann, Britt M4 aut
700	1	a Spazzolini, Carla4 aut
700	1	a Rordorf, Roberto4 aut
700	1	a Rydberg, Annikau Umeå universitet,Pediatrik4 aut0 (Swepub:umu)anry0014
700	1	a Clur, Sally-Ann B4 aut
700	1	a Fischer, Markus4 aut
700	1	a van den Heuvel, Freek4 aut
700	1	a Kaeaeb, Stefan4 aut
700	1	a Blom, Nico A4 aut
700	1	a Ackerman, Michael J4 aut
700	1	a Schwartz, Peter J4 aut
700	1	a Wilde, Arthur AM4 aut
710	2	a Umeå universitetb Pediatrik4 org
773	0	t Journal of the American College of Cardiologyd : Elsevier BVg 60:20, s. 2092-2099q 60:20<2092-2099x 0735-1097x 1558-3597
856	4	u https://doi.org/10.1016/j.jacc.2012.07.046
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-62152
856	4 8	u https://doi.org/10.1016/j.jacc.2012.07.046

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