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β1-Adrenoceptor Blocker Aggravated Ventricular Arrhythmia

Authors

  • YAN WANG M.D.,

    Corresponding author
    1. Cardivascular Division, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
    • Address for reprints: Yan Wang or Dao Wen Wang, M.D., Ph.D., Cardiovascular Division, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. Fax: 86-27-8366-3280; e-mail: newswangyan@tjh.tjmu.edu.cn

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  • DIMPI PATEL M.D.,

    1. Mercy St. Vincents Medical Center, Toledo, Ohio
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  • DAO WU WANG M.D.,

    1. Cardiovascular Division, Affiliated Hospital of Nanjing Medical University, Nanjing, P. R. China
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  • JIANG TAO YAN M.D.,

    1. Cardivascular Division, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
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  • HENRY H. HSIA M.D.,

    1. Cardiovascular Medicine Division, Stanford University, Stanford, California
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  • HAO LIU M.D.,

    1. Cardiovascular Institute, First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
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  • CHUN XIA ZHAO M.D.,

    1. Cardivascular Division, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
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  • HOU JUAN ZUO M.D.,

    1. Cardivascular Division, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
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  • DAO WEN WANG M.D

    Corresponding author
    1. Cardivascular Division, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
    • Address for reprints: Yan Wang or Dao Wen Wang, M.D., Ph.D., Cardiovascular Division, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. Fax: 86-27-8366-3280; e-mail: newswangyan@tjh.tjmu.edu.cn

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  • This work was supported by grants from the National Natural Science Foundation of China (No. 81070236) and the 973 Program of China (No. 2012CB517801).

  • Conflicts of interest: None.

Abstract

Objectives

To assess the impact of β1-adrenoceptor blockers (β1-blocker) and isoprenaline on the incidence of idiopathic repetitive ventricular arrhythmia that apparently decreases with preprocedural anxiety.

Methods

From January 2010 to July 2012, six patients were identified who had idiopathic ventricular arrhythmias that apparently decreased (by greater than 90%) with preprocedural anxiety. The number of ectopic ventricular beats per hour (VPH) was calculated from Holter or telemetry monitoring to assess the ectopic burden. The mean VPH of 24 hours from Holter before admission (VPH-m) was used as baseline (100%) for normalization. β1-Blockers, isoprenaline, and/or aminophylline were administrated successively on the ward and catheter lab to evaluate their effects on the ventricular arrhythmias.

Results

Among 97 consecutive patients with idiopathic ventricular arrhythmias, six had reduction in normalized VPHs in the hour before the scheduled procedure time from (104.6 ± 4.6%) to (2.8 ± 1.6%) possibly due to preprocedural anxiety (P < 0.05), then increased to (97.9 ± 9.7%) during β1-blocker administration (P < 0.05), then quickly reduced to (1.6 ± 1.0%) during subsequent isoprenaline infusion. Repeated β1-blocker quickly counteracted the inhibitory effect of isoprenaline, and VPHs increased to (120.9 ± 2.4%) from (1.6 ± 1.0%; P < 0.05). Isoprenaline and β1-blocker showed similar effects on the arrhythmias in catheter lab.

Conclusions

In some patients with structurally normal heart and ventricular arrhythmias there is a marked reduction of arrhythmias associated with preprocedural anxiety. These patients exhibit a reproducible sequence of β1-blocker aggravation and catecholamine inhibition of ventricular arrhythmias, including both repetitive ventricular premature beats and monomorphic ventricular tachycardia.

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