Preview

Rational Pharmacotherapy in Cardiology

Advanced search

COMPARATIVE EFFICACY OF AMIODARONE AND BISOPROLOL IN TREATMENT OF VENTRICULAR PREMATURE BEATS IN PATIENTS WITH METABOLIC SYNDROME

https://doi.org/10.20996/1819-6446-2009-5-6-29-34

Full Text:

Abstract

Aim. Comparative study of amiodarone and bisoprolol efficacy in patients with ventricular arrhythmia and metabolic syndrome.

Methods. 146 patients with the AHA/NHLBI 2005 metabolic syndrome and symptomatic ventricular arrhythmia were included in the study. 52 patients received regular oral amiodarone (200 mg daily, 5 days a week) therapy, 55 patients received bisoprolol (10 mg daily) treatment and 39 patients did not receive any antiarrhythmic therapy (control group). Treatment efficacy was evaluated by Holter monitoring (before start and after 1, 3, 6, 9, 12 months of therapy).

Results. Significant efficacy advantage of bisoprolol vs this of amiodarone was observed in 12 months of therapy (50.0% of effectively treated patients vs 17.3%, p=0.02). Significant difference in a number of patients ceased therapy because of antiarrhythmic effect loss was also revealed (20.0% vs 46.1%, p=0.004). A number of patients stopped therapy because of side effects was comparable in the both groups. Patient age younger than 42 years old in combination with a number of ventricular premature beats morphology less than 4 allowed predicting effective antiarrhythmic treatment for both drugs with sensitivity of 70.3% and specificity of 65.0%.

Conclusion. Bisoprolol have an advantage (versus amiodarone) within 9-12 month therapy in patients with ventricular premature beats and metabolic syndrome. Drug refractoriness and side effects monitoring is necessary.

About the Authors

V. M. Provotorov
Voronezh State Medical Academy named after N.N. Burdenko of Federal Agency for Health Care and Social Development
Russian Federation
Studencheskaya ul. 10, Voronezh, 394036


M. L. Gluhovsky
Voronezh State Medical Academy named after N.N. Burdenko of Federal Agency for Health Care and Social Development
Russian Federation
Studencheskaya ul. 10, Voronezh, 394036


References

1. Zipes D.P., Camm A.J., Borggrefe M. et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of theAmerican College of Cardiology/AmericanHeartAssociation Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006;114:e385-484.

2. Sato M., Kohya T., YokoshikiH., Kitabatake A. The trend of anti-arrhythmic drug development [in Japanese]. Nippon Rinsho 2002;60(7):1341–7.

3. Erdogan O. Holter monitoring in the prognosis of sudden cardiac death. Anadolu Kardiyol Derg 2007;7 Suppl 1:64–7.

4. Morganroth J. Evaluation of antiarhythmic therapy using Holter monitoring. Am J Cardiol 1988;62(12):18H-23H.

5. Grundy S.M., Cleeman J.I., Daniels S.R. et al. Diagnosis and Management of the Metabolic Syndrome: An AmericanHeart Association/NationalHeart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52.

6. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2007;30 Supplement 1:S42–7.

7. Диагностика и лечение стабильной стенокардии. Российские рекомендации Комитета экспертов Всероссийского научного общества кардиологов. Кардиоваскулярная терапия и профилактика 2004;(4 приложение 1):7-12.

8. Cuspidi C., Meani S., Fusi V. et al. Prevalence and correlates of left atrial enlargement in essential hypertension:role of ventricular geometry and the metabolic syndrome: the Evaluation of Target Organ Damage in Hypertension study. J Hypertens 2005;23:875-82.

9. Chibalin A.V. Regulation of the Na,K-ATPase: Special implications for cardiovascular complications of metabolic syndrome. Pathophysiology 2007;14:153-8.

10. Abel E.D. Myocardial insulin resistance and cardiac complications of diabetes. Curr Drug Targets Immune Endocr Metabol Disord. 2005;5(2):219-26.

11. Chiu H.C., Kovacs A., Blanton R.M. et al. Transgenic expression of fatty acid transport protein 1 in the heart causes lipotoxic cardiomyopathy. Circ Res 2005;96:225-33.

12. Искендеров Б.Г., Лохина Т.В., Шибаева Т.М. и др. Динамика электрофизиологических показателей сердца у больных артериальной гипертонией в зависимости от суточного профиля артериального давления, геометрии левого желудочка и метаболических нарушений. Тер арх 2006;78(9):12–6.

13. Soydinc S., Davutoglu V., Akcay M. Uncomplicated metabolic syndrome is associated with prolonged electrocardiographic QTc interval and QTc dispersion. Ann Noninvasive Electrocardiol 2006;11(4):313-7.

14. Liao D., Sloan R.P., Cascio W.E. et al. Multiple metabolic syndrome is associated with lower heart rate variability. The Atherosclerosis Risk in Communities Study. Diabetes Care 1998;21(12): 2116-22.

15. Кипшидзе Н.Н., Кацитадзе Г.А., Хосрошвили Л.Б. Влияние метаболического синдрома на электрофизиологические параметры проводящей системы сердца. Медицинские новости Грузии 2005;(119):9-13.

16. Umetani K., Kodama Y., Nakamura T. High prevalence of paroxysmal atrial fibrillation and/or atrial flutter in metabolic syndrome. Circ J 2007; 71:252–5.

17. Шурыгина В.Д., Шубик Ю.В. Нарушения ритма сердца при метаболическом синдроме. Вестник аритмологии 2008;(53):56–63.

18. Drenick E.J., Fisler J.S. Sudden cardiac arrest in morbidly obese surgical patients unexplained after autopsy. Am J Surg 1988;155:720–6.

19. Sjostrom L.V. Mortality of severely obese subjects.Am J Clin Nutr 1992;55(2 Suppl):516S–523S.

20. Jimenez R.A., Myerburg R.J. Sudden cardiac death. Magnitude of the problem, substrate/trigger interaction, and populations at high risk. Cardiol Clin 1993;11:1–9.

21. Messerli F.H., Nunez B.D., Ventura H.O., et al. Overweight and sudden death. Increased ventricular ectopy in cardiopathy of obesity. Arch Intern Med 1987;147:1725–8.

22. MacMahon S.W., WilckenD.E., Macdonald G.J. The effect of weightreduction on left ventricular mass. A randomized controlled trial in young, overweight hypertensive patients. N Engl J Med 1986;314:334–9.

23. Alpert M.A., Lambert C.R., Terry B.E. et al. Effect of weight loss on left ventricular mass in non￾hypertensive morbidly obese patients. Am J Cardiol 1994;73:918–21.

24. Huggett R.J., Burns J., Mackintosh A.F., Mary D.A. Sympathetic neural activation in nondiabetic metabolic syndrome and its further augmentation by hypertension.Hypertension2004;44(6):847- 52.

25. Bharati S., Lev M. Cardiac conduction system involvement in sudden death of obese young people. Am Heart J 1995;129:273–81.

26. Balsaver A.M., Morales A.R., Whitehouse FW. Fat infiltration of myocardium as a cause of cardiac conduction defect. Am J Cardiol 1967;19:261–5.

27. Spain D.M., Cathcart R.T. Heart block caused by fat infiltration of the inter-ventricular septum (cor adiposum). Am Heart J 1946;32:659–64.

28. Zhou Y.T., Grayburn P., Karim A., et al. Lipotoxic heart disease in obese rats: implications for human obesity. Proc Natl Acad Sci U S A 2000;97:1784–9.

29. Marcus F.I. Clinical pharmacology of amiodarone. Ann NY Acad Sci 1984;427:112–26.


For citation:


Provotorov V.M., Gluhovsky M.L. COMPARATIVE EFFICACY OF AMIODARONE AND BISOPROLOL IN TREATMENT OF VENTRICULAR PREMATURE BEATS IN PATIENTS WITH METABOLIC SYNDROME. Rational Pharmacotherapy in Cardiology. 2009;5(6):29-34. (In Russ.) https://doi.org/10.20996/1819-6446-2009-5-6-29-34

Views: 2356


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)