Not all beta-blockers are equal in the management of long QT syndrome types 1 and 2: Higher recurrence of events under metoprolol

Priya Chockalingam, Lia Crotti, Giulia Girardengo, Jonathan N. Johnson, Katy M. Harris, Jeroen F. Van Der Heijden, Richard N W Hauer, Britt M. Beckmann, Carla Spazzolini, Roberto Rordorf, Annika Rydberg, Sally Ann B Clur, Markus Fischer, Freek Van Den Heuvel, Stefan Kääb, Nico A. Blom, Michael J. Ackerman, Peter J. Schwartz, Arthur A M Wilde

Research output: Contribution to journalArticlepeer-review

Abstract

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 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.

Original languageEnglish
Pages (from-to)2092-2099
Number of pages8
JournalJournal of the American College of Cardiology
Volume60
Issue number20
DOIs
Publication statusPublished - Nov 13 2012

Keywords

  • breakthrough cardiac events
  • congenital long QT syndrome
  • metoprolol
  • nadolol
  • propranolol

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Not all beta-blockers are equal in the management of long QT syndrome types 1 and 2: Higher recurrence of events under metoprolol'. Together they form a unique fingerprint.

Cite this