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Experience with bisoprolol in long-QT1 and long-QT2 syndrome

  • Christian Steinberg
  • Gareth J. Padfield
  • Basil Al-Sabeq
  • Arnon Adler
  • John A. Yeung-Lai-Wah
  • Charles R. Kerr
  • Marc W. Deyell
  • Jason G. Andrade
  • Matthew T. Bennett
  • Raymond Yee
  • George J. Klein
  • Martin Green
  • Zachary W. M. Laksman
  • Andrew D. Krahn
  • Santabhanu Chakrabarti
MULTIMEDIA REPORT

Abstract

Background

The protective effect of beta-blockers in patients with inherited Long-QT syndrome is well established. Recent reports have suggested that beta-blockers are not equally effective in Long-QT (LQT). Bisoprolol is an attractive candidate for use in LQT because of its cardioselective properties and favorable side-effect profile.

Methods

We performed a retrospective cohort study of 114 consecutive patients with gene-positive Long-QT syndrome type 1 (LQT1) or Long-QT syndrome type 2 (LQT2) treated with bisoprolol, nadolol or atenolol with a total of 580 person-years of follow-up. Electrocardiogram (ECG) parameters and cardiac events during follow-up were compared. In addition, exercise treadmill testing was performed in bisoprolol-treated patients.

Results

Fifty-nine patients were treated with bisoprolol, 39 with atenolol and 16 with nadolol. Overall, 59 % were females and 62 % had LQT1. Baseline heart rate and corrected QT (QTc) interval were similar between the groups. QTc shortening was observed in individuals on bisoprolol (ΔQTc −5 ± 31 ms; p = 0.049) and nadolol (ΔQTc −13 ± 16 ms; p = 0.02) but not on atenolol (ΔQTc +9 ± 24 ms; p = 0.16). Median follow-up was similar for bisoprolol and nadolol (3 years), but longer for atenolol (6 years; p = 0.03); one cardiac event occurred in the bisoprolol group (1.7 %) and two events occurred in the atenolol group (5.1 %; p = 0.45), whereas none occurred in nadolol-treated patients. Beta-blocker efficacy was not affected by the underlying genotype. The antiadrenergic effect of bisoprolol correlated with the reduction of peak heart rates at exercise testing.

Conclusions

Bisoprolol treatment results in QTc shortening in gene-positive LQT1 and LQT2 patients and is well tolerated during long-term administration. The equivalence of bisoprolol for protection from ventricular arrhythmia in LQT patients compared to established beta-blockers remains unknown. Further large-scale studies are required.

Keywords

Long-QT Beta-blocker Bisoprolol LQT1 LQT2 Channelopathy Inherited arrhythmia 

Abbreviations

BB

Beta-blocker

Bpm

Beats per minute

ECG

Electrocardiogram

HR

Heart rate

ICD

Implantable cardioverter defibrillator

IQR

Interquartile range

LQT

Long-QT syndrome

LQT1

Long-QT syndrome type 1

LQT2

Long-QT syndrome type 2

N/A

Not applicable

QTa

Absolute QT interval

QTc

Corrected QT interval

SCD

Sudden cardiac death

SD

Standard deviation

Notes

Compliance with ethical standards

The study was approved by the local ethics and review board of each participating center.

Funding

None

Conflict of interest

The authors declare that they have no conflict of interest

Supplementary material

10840_2016_161_MOESM1_ESM.tiff (70 kb)
Supplementary Figure 1 Shown are the resting heart rates for LQTS-1 (A) and LQTS-2 (B) prior to beta-blocker initiation and on stable beta-blocker dose. Data are presented as mean ± SD. (TIFF 70 kb)

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Christian Steinberg
    • 1
  • Gareth J. Padfield
    • 1
  • Basil Al-Sabeq
    • 2
  • Arnon Adler
    • 3
  • John A. Yeung-Lai-Wah
    • 1
  • Charles R. Kerr
    • 1
  • Marc W. Deyell
    • 1
  • Jason G. Andrade
    • 1
  • Matthew T. Bennett
    • 1
  • Raymond Yee
    • 2
  • George J. Klein
    • 2
  • Martin Green
    • 3
  • Zachary W. M. Laksman
    • 1
  • Andrew D. Krahn
    • 1
  • Santabhanu Chakrabarti
    • 1
    • 4
  1. 1.Heart Rhythm Services, Division of Cardiology, Department of MedicineUniversity of British ColumbiaVancouverCanada
  2. 2.Division of Cardiology, Department of MedicineWestern UniversityLondonCanada
  3. 3.Division of CardiologyUniversity of Ottawa Heart InstituteOttawaCanada
  4. 4.Heart Rhythm ServicesSt. Paul’s HospitalVancouverCanada

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