Comparing beta-blockers in CPVT
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare heart disease. Patients with CPVT have a disturbed electrical function of the heart. Catecholamines are hormones that are released during exercise or emotional triggers. Catecholamines can trigger a faster heart rate because they activate certain receptors called beta-receptors. In patients with CPVT, the heart is more sensitive to catecholamines. The catecholamines may cause the heart to beat too fast, irregular and ineffective. The main function of the heart – pumping oxygenated blood through the body, is therefore hampered. This can lead to the following symptoms: syncope or – if the rhythm is not returned to normal – even death. Especially children who have already suffered a syncope (‘blackout’) or resuscitation are at risk for the recurrence of symptoms.
Beta-blockers are important medicines for patients with CPVT. Beta-blockers act by blocking the beta-receptors, inhibiting catecholamines to trigger effects in the heart. Many different sorts of beta-blockers are at hand. Non-selective beta-blockers block more receptors compared to selective beta-blockers, that only block a specific type. Therefore, not all different types of beta-blockers might be equally effective in the treatment of patients with CPVT.
In this study, we sought to investigate if there is a difference in efficacy between the different types of beta-blockers (selective beta-blockers and non-selective beta-blockers) and the mostly prescribed beta-blockers individually (selective beta-blockers: metoprolol, bisoprolol and atenolol, non-selective beta-blockers: nadolol and propranolol). For this purpose, we looked back into patient data of symptomatic children with CPVT from around the world. We used information about the diagnosis, the exact treatment, and information about whether or not a patient had symptoms. In total, we used data from 329 patients in this study. Patients who used non-selective beta-blockers, specifically nadolol, had a lower risk for symptoms compared to patients who used selective beta-blockers. Therefore, non-selective beta-blockers, specifically nadolol which seems to work the best, should be the favoured beta-blocker in the treatment of symptomatic children with CPVT.
Translated by Puck Peltenburg, Amsterdam UMC, Amsterdam, The Netherlands
Peltenburg PJ, Kallas D, Bos JM, Lieve KVV, Franciosi S, Roston TM, Denjoy I, Sorensen KB, Ohno S, Roses-Noguer F, Aiba T, Maltret A, LaPage MJ, Atallah J, Giudicessi JR, Clur SB, Blom NA, Tanck M, Extramiana F, Kato K, Barc J, Borggrefe M, Behr ER, Sarquella-Brugada G, Tfelt-Hansen J, Zorio E, Swan H, Kammeraad JAE, Krahn AD, Davis A, Sacher F, Schwartz PJ, Roberts JD, Skinner JR, van den Berg MP, Kannankeril PJ, Drago F, Robyns T, Haugaa KH, Tavacova T, Semsarian C, Till J, Probst V, Brugada R, Shimizu W, Horie M, Leenhardt A, Ackerman MJ, Sanatani S, van der Werf C, Wilde AAM. An International Multi-Center Cohort Study on β-blockers for the Treatment of Symptomatic Children with Catecholaminergic Polymorphic Ventricular Tachycardia. Circulation 145, 333-344, 2022. PMID: 34874747.