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Comparative Characteristics of Beta-Blockers in Patients with Congenital Long QT Syndrome

https://doi.org/10.20996/1819-6446-2021-06-19

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Abstract

Congenital long QT syndrome is a pathology that requires special attention and knowledge about the safety and effectiveness of various medications. Prolongation of the QT interval due to congenital or acquired causes is an important factor in the development of an unfavorable life forecast with the formation of an elongated QT syndrome. With an unfavorable course, patients suffer from loss of consciousness, episodes of tachycardia. Often, stable polymorphic ventricular tachycardia develops. The risk of sudden cardiac death in this pathology can vary from 0.33% to 5%. In people who have suffered an episode of cardiac arrest, and do not have a permanent prescribed antiarrhythmic therapy, the mortality rate reaches 50% within 15 years. Preventive administration of antiarrhythmic drugs is not always effective. A positive result of treatment depends on the severity of long QT syndrome and its genotype. Beta-blockers are often prescribed to patients of different ages with various cardiac pathologies, including for the prevention of arrhythmia in long QT syndrome. Beta-blockers differ in various pharmacokinetic and pharmacodynamic parameters (lipophilicity/hydrophilicity, selectivity, presence/absence of internal sympathomimetic activity), which, along with the variant of the disease genotype, can affect their effectiveness and safety in the considered pathology. This review article presents the results of major studies on the safety and effectiveness of different groups of beta blockers in various variants of long QT syndrome. The preferred beta-blockers for various genotypes of the syndrome were determined, and a comparative characteristic of beta-blockers for their safety and preventive effectiveness was given.

About the Authors

A. Yu. Proshlyakov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Alexey Y Proshlyakov



P. Sh. Chomakhidze
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Peter Sh. Chomakhidze - eLibrary SPIN 6230-5610



N. A. Novikova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Nina A. Novikova - eLibrary SPIN 7876-8609



References

1. Rautaharju PM, Surawicz B, Gettes LS. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram Part IV: The ST Segment, T and U Waves, and the QT Interval A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology, the American College of Cardiology Foundation, and the Heart Rhythm Society Circulation. 2009,1 19:241-50. DOI:10.1016/j.jacc.2008.12.014.

2. Pickham D, Hasanien A.A. ECG Challenges: Measurement and Rate Correction of the QT Interval. AACN Advanced Critical Care 2013,24(1):90-6. DOI:10.1097/NCI.0b013e318274ba3e.

3. Al-Khatib SM, LaPointe NM, Kramer JM, Califf RM. What clinicians should know about the QT interval. JAMA. 2003,289(4):2120-7. DOI:10.1001/jama.289.16.2120.

4. Doschitsin VL. Clinical analysis of electrocardiograms. Moscow: Medicine, 1 982 (In Russ.)5. Kuszakowski MS. Cardiac arrhythmias. St. Petersburg: IKF Foliant, 1998 (In Russ.) [Кушаковский М.С. Аритмии сердца. СПб.: ИКФ Фолиант, 1998].

5. Makarov LM, Chuprova SN, Kiseleva II. Comparison of methods for measuring the QT interval and their clinical significance. Kardiologiia. 2004,(5):71-3 (In Russ.)

6. Kannankeril P, Roden DM, Darbar D. Drug-Induced Long QT Syndrome. Pharmacol Rev. 2010,62(4): 760-81. DOI:10.1124/pr.110.003723.

7. Chiang CE, Roden DM. The long-QT syndromes: genetic basis and clinical implications. J Am Coll Cardiol. 2000,36(1):1-12. DOI:10.1016/s0735-1097(00)00716-6.

8. Doschitsin VL, Segal ES, Sedov VV. ECG QT interval prolongation: classification, clinical significance. Kardiologiia. 1981,10:22-8 (In Russ.) [Дощицин В.Л., Сигал Е.С., Седов В.В. Удлинение интервала QT ЭКГ: классификация, клиническое значение. Кардиология. 1981,10:22-8].

9. Schwartz PJ, Crotti L, Insolia R. Long-QTsyndrome: from genetics to management. Circ Arrhythm Electrophysiol. 2012,5(4):868-77. DOI:10.1161/CIRCEP.111.962019.

10. Refsgaard L, Holst AG, Sadjadieh G, et al. High prevalence of genetic variants previously associated with LQT syndrome in new exome data. Eur J Hum Genet. 2012,20(8):905-8. DOI:10.1038/ejhg.2012.23.

11. Antzelevitch C, Oliva A. Amplification of spatial dispersion of repolarization underlies sudden cardiac death associated with catecholaminergic polymorphic VT, long QT, short QT and Brugada syndromes. J Intern Med. 2006,259(1):48-58. DOI:10.1111/j.1365-2796.2005.01587.x.

12. Chiang CE, Roden DM. The long QT syndromes: genetic basis and clinical implications. J Am Coll Cardiol. 2000,36(1):1-12. DOI:10.1016/s0735-1097(00)00716-6.

13. Nakano Y Shimizu W. Genetics of long-QT syndrome. J Hum Genet 2016,61 (1 ):51-5. DOI:10.1038/jhg.2015.74.

14. Modell SM, Lehmann MH. The long-QT syndrome family of cardiac ion channelopathies: a HuGE review. Genet Med. 2006,8(3):143-55.

15. Moss AJ, Robinson J. Clinical features of the idiopathic long QT syndrome. Circulation. 1 992,85(1 Suppl):I140-4.

16. Moss AJ, Schwartz PJ, Crampton RS, et al. The long QT syndrome. Prospective longitudinal study of 328 families. Circulation. 1991,84(3):1 136-44. DOI:10.1161/01.cir.84.3.1136.

17. Priori SG, Blomstrom-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015,36(41):2793-867. DOI:10.1093/eurheartj/ehv316.

18. Schwartz PJ. Idiopathic long QT syndrome: progress and questions. Am Heart J. 1 985,1 09(2):399-411. DOI:10.1016/0002-8703(85)90626-x.

19. Vincent GM. The molecular genetics of the long QT syndrome: genes causing fainting and sudden death. Annu Rev Med. 1998,49:263-74. DOI:10.1146/annurev.med.49.1.263.

20. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society J Am Coll Cardiol. 2018,72(14):e91-e220. DOI:10.1016/j.jacc.2017.10.054.

21. Priori SG, Wilde AA, Horie M, et al. Executive summary: HRS/EHRA/APHRS consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace 2013,1 5(10):1 389-406. DOI:10.1093/europace/eut272.

22. Kim JA, Lopes CM, Moss AJ, et al. Trigger-specific risk factors and response to therapy in long-QT syndrome type 2. Heart Rhythm. 2010,7(12):1797-805. DOI:10.1016/j.hrthm.2010.09.011.

23. Schwartz PJ, Priori SG, Spazzolini C, et al. Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation. 2001 ,103(1 ):89-95. DOI:10.1161/01.cir.103.1.89.

24. Goldenberg I, Thottathil P, Lopes CM, et al. Trigger-specific ion-channel mechanisms, risk factors, and response to therapy in type 1 long QT syndrome. Heart Rhythm/ 2012 ,9( 1) :49-56. DOI:10.1016/j.hrthm.2011.08.020.

25. Lopatin YM. Diuretics and the development of hyperkalemia in patients with arterial hypertension: Are the security of the original and generic drugs. Atmosphere. Cardiology. 2004,(3):12-5 (In Russ.)

26. Schwartz PJ, Moss AJ, Vincent GM. Diagnostic criteria for the long QT syndrome: an update. Circulation. 1993,88(2):782-4. DOI:10.1161/01.cir.88.2.782.

27. Moss AJ, Zareba W, Hall WJ, et al. Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome. Circulation. 2000,101(6):616-23. DOI:10.1161/01.cir.101.6.616.

28. Priori SG, Napolitano C, Schwartz PJ, et al. Association of long QT syndrome loci and cardiac events among patients treated with beta-blockers. JAMA. 2004,292(1 1 ):1 341-4. DOI: 10.1001/jama.292.11.1341.

29. Villain E, Denjoy I, Lupoglazoff JM, et al. Low incidence of cardiac events with beta-blocking therapy in children with long QT syndrome. Eur Heart J. 2004,25(1 6):1 405-1 1. DOI:10.1016/j.ehj.2004.06.016.

30. Chockalingam P, Crotti L, Girardengo G, et al. Not all beta-blockers are equal in the management of long QT syndrome types 1 and 2: higher recurrence of events under metoprolol. J Am Coll Cardiol. 2012,60(20):2092-9. DOI:10.1016/j.jacc.2012.07.046.

31. Chatrath R, Bell CM, Ackerman MJ. Beta-blocker therapy failures in symptomatic probands with genotyped long-QT syndrome. Pediatric Cardiology. 2004,25(5):459-65. DOI:10.1007/s00246-003-0567-3.

32. Vincent GM, Schwartz PJ, Denjoy I, et al. High efficacy of beta-blockers in long-QT syndrome type 1: contribution of noncompliance and QT-prolonging drugs to the occurrence of beta-blocker treatment "failures". Circulation. 2009,119(2):215-21. DOI:10.1161/CIRCULATIONAHA.108.772533.

33. Ackerman MJ. Genotype-phenotype relationships in congenital long QT syndrome. J Electrocardiol. 2005,38(4 Suppl):64-8. DOI:10.1016/j.jelectrocard.2005.06.018.

34. Ali RH, Zareba W, Moss AJ, et al. Clinical and genetic variables associated with acute arousal and nonarousal-related cardiac events among subjects with long QT syndrome. Am J Cardiol. 2000,85(4):457-61. DOI:10.1016/s0002-9149(99)90772-5.

35. McAinsh J, Cruickshank JM. Beta-blockers and central nervous system side effects. Pharmacol Ther. 1990,46(2):163-97. DOI:10.1016/0163-7258(90)90092-g.

36. Lewis RV, Lofthouse C. Adverse reactions with beta-adrenoceptor blocking drugs: an update. Drug Saf. 1993,9(4):272-9. DOI:10.2165/00002018-199309040-00005.

37. Calvillo L, Spazzolini C, Vullo E, et al. Propranolol prevents life-threatening arrhythmias in LQT3 transgenic mice: implications for the clinical management of LQT3 patients. Heart Rhythm. 2014,1 1(1):1 26-32. DOI:10.1016/j.hrthm.2013.10.029.

38. Wilde AA, Moss AJ, Kaufman ES, et al. Clinical Aspects of Type 3 Long-QT Syndrome: An International Multicenter Study Circulation. 2016,1 34(1 2):872-82. DOI: 10.1161/CIRCULATIONAHA.116.021823.

39. Besana A, Wang DW, George AL Jr, Schwartz PJ. Nadolol block of Nav1.5 does not explain its efficacy in the long-QT syndrome. J Cardiovasc Pharmacol. 2012,59(3):249-53. DOI:10.1097/FJC.0b013e31823d2fd1.

40. Abu-Zeitone A, Peterson DR, Polonsky B, et al. Efficacy of different beta-blockers in the treatment of long QT syndrome. J Am Coll Cardiol. 2014,64(1 3):1352-8. DOI:10.1016/j.jacc.2014.05.068.

41. Goldenberg I, Bradley J, Moss AJ, et al. Beta-blocker efficacy in high-risk patients with the congenital long-QT syndrome types 1 and 2: implications for patient management. J Cardiovasc Electrophysiol. 2010,21(8):893-901. DOI:10.1111/j.1540-8167.2010.01737.x.

42. Ahn J, Kim HJ, Choi JI, et al. Effectiveness of beta-blockers depending on the genotype of congenital long-QT syndrome: A meta-analysis. PLoS ONE. 2017,12(10):e0185680. DOI:10.1371/journal.pone.0185680.

43. Steinberg C, Padfield GJ, Al-Sabeq B, et al. Experience with bisoprolol in long-QT 1 and long-QT2 syndrome. J Interv Card Electrophysiol. 2016,47(2):1 63-70. DOI:10.1007/s10840016-0161-2.

44. Mazzanti A, Maragna R, Vacanti G, et al. Interplay Between Genetic Substrate, QTc Duration, and Arrhythmia Risk in Patients With Long QT Syndrome. J Am Coll Cardiol. 2018,71(1 5):1663-71. DOI:10.1016/j.jacc.2018.01.078.

45. Wang DW, Mistry AM, Kahlig KM, et al. Propranolol blocks cardiac and neuronal voltage-gated sodium channels. Front Pharmacol. 2010,1:144. DOI:10.3389/fphar.2010.00144.

46. Fazio G, Vernuccio F, Lo Re G, et al. Role of bisoprolol in patients with long QT syndrome. Ann Noninvasive Electrocardiol. 2013,18(5):467-70. DOI:10.1111/anec.12047.

47. Chorin E, Dai M, Shulman E, et al. The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin. Heart Rhythm. 2020,17(9):1 425-33. DOI:10.1016/j.hrthm.2020.05.014.

48. Koponen M, Marjamaa A, Hiippala A, et al. Follow-Up of 316 Molecularly Defined Pediatric Long-QT Syndrome Patients. Circ Arrhythm Electrophysiol. 2015,8(4):815-23. DOI:10.1161/CIR-CEP.114.002654.

49. Itoh T, Kikuchi K, Odagawa Y et al. Correlation of genetic etiology with response to beta-adrenergic blockade among symptomatic patients with familial long-QT syndrome. Journal of Human Genetics. 2001,46(1):38-40. DOI:10.1007/s100380170123.

50. Mizusawa Y Horie M, Wilde AA. Genetic and clinical advances in congenital long QT syndrome. Circulation journal: official journal of the Japanese Circulation Society 2014,78(1 2):2827-33. DOI:10.1253/circj.cj-14-0905.

51. Goldenberg I, Zareba W, Moss AJ. Long QT Syndrome. Curr Probl Cardiol. 2008,33(1 1):629-94. DOI:10.1016/j.cpcardiol.2008.07.002.

52. Amin AS, Asghari-Roodsari A, Tan HL. Cardiac sodium channelopathies. Pflugers Arch. 2010,460(2):223-37. DOI:10.1007/s00424-009-0761-0.

53. Ishibashi K, Aiba T, Kamiya C, et al. Arrhythmia risk and p-blocker therapy in pregnant women with long QT syndrome. Heart. 2017,103(1 7):1374-9. DOI:10.1136/heartjnl-2016-310617.

54. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy Eur Heart J. 2018,39(34):3165-241. DOI:10.1093/eurheartj/ehy340.

55. Seth R, Moss A.J, McNitt S, et al. Long QT syndrome and pregnancy. J Am Coll Cardiol. 2007,49(10):1 092-8. DOI:10.1016/j.jacc.2006.09.054.

56. Ackerman MJ, Priori SG, Dubin AM, et al. Beta-blocker therapy for long QT syndrome and cate-cholaminergic polymorphic ventricular tachycardia: Are all beta-blockers equivalent? Heart Rhythm. 2017,14(1):e41-e44. DOI:10.1016/j.hrthm.2016.09.012.


For citation:


Proshlyakov A.Yu., Chomakhidze P.S., Novikova N.A. Comparative Characteristics of Beta-Blockers in Patients with Congenital Long QT Syndrome. Rational Pharmacotherapy in Cardiology. 2021;17(3):492-497. (In Russ.) https://doi.org/10.20996/1819-6446-2021-06-19

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ISSN 1819-6446 (Print)
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