Therapeutic Inefficacy and Proarrhythmic Nature of Metoprolol Succinate and Carvedilol Therapy in Patients with Idiopathic, Frequent, Monomorphic Premature Ventricular Contractions

TURAN O. E., Aydin M., Odabasi A. Y., Inc M., Payzin S., Hasdemir C.

American Journal of Therapeutics, vol.29, no.1, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 29 Issue: 1
  • Publication Date: 2022
  • Doi Number: 10.1097/mjt.0000000000001372
  • Journal Name: American Journal of Therapeutics
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CAB Abstracts, CINAHL, EMBASE, MEDLINE
  • Keywords: premature ventricular contraction, idiopathic ventricular arrhythmia, antiarrhythmic drugs, metoprolol succinate, carvedilol, proarrhythmia, OUTFLOW TRACT, TACHYCARDIA, SUPPRESSION, MANAGEMENT
  • Karadeniz Technical University Affiliated: Yes


1075-2765 Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.Background: Antiarrhythmic drugs remain the first-line therapy for treatment of idiopathic ventricular arrhythmias. Study Question: The aim of this study was to assess the therapeutic efficacy of extended-release metoprolol succinate (MetS) and carvedilol for idiopathic, frequent, monomorphic premature ventricular contractions (PVCs). Study Design: Study population consisted of 114 consecutive patients: 71 received MetS and 43 received carvedilol. Measures and Outcomes: All patients underwent 24-hour Holter monitoring at baseline and during drug therapy. PVC-burden response to drug therapy was categorized as “good” ($80% reduction), “poor” (either,80% reduction or #50% increase), and “proarrhythmic” responses (.50% increase) based on change in PVC burden compared with baseline. Results: Most common presenting symptom was palpitations (65.8%), followed by coincidental discovery (29%). The mean MetS and carvedilol dosages were 65.57 6 30.67 mg/d and 23.66 6 4.26 mg/d, respectively. “Good,” “poor,” and “proarrhythmic” responses were observed in 11.3% and 16.3%, 63.4% and 67.4%, and 25.3% and 16.3% of patients treated with MetS and carvedilol, respectively. In patients with relatively high ($16%) PVC burden, the sum of “poor”/“proarrhythmic” response was observed in 95.5% and 86.4% of patients treated with MetS and carvedilol, respectively. “Proarrhythmic” response was observed in 21.9% of the patients, particularly in the presence of relatively lower (#10%) baseline PVC burden. Patients with “good” response during beta-blocker therapy had higher baseline daily average intrinsic total heart beats compared with patients with “poor”/“proarrhythmic” response combined (96,437 6 26,488 vs. 86,635 6 15,028, P 5 0.047, respectively). Side effects and intolerance were observed in 5.6% and 18.6% of patients treated with MetS and carvedilol, respectively. Conclusions: MetS and carvedilol for idiopathic, frequent, monomorphic PVCs are frequently inefficient. Therapeutic efficacy decreases further in patients with relatively high ($16%) PVC burden. Relatively higher baseline daily intrinsic total heart beats may be used to predict “good” response before beta-blocker therapy.