Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias
T. Schupp1, S. Ziyadova1, M. von Zworowsky1, L. Reiser1, M. Abumayyaleh1, K. J. Weidner1, K. A. Mashayekhi2, T. Bertsch3, I. Akin1, M. Behnes1
1I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; 2Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg / Bad Krozingen, Bad Krozingen; 3Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin, Klinikum Nürnberg Nord, Nürnberg;

Objective: The study investigates the prognostic role of treatment with carvedilol as compared to metoprolol in patients with ventricular tachyarryhthmias.

Background: Limited data regarding the prognostic impact of different types of beta-blockers (BB) in ventricular tachyarrhythmias is available.
Methods: A large retrospective registry was used including consecutive patients on BB treatment with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Patients treated with carvedilol were compared to patients with metoprolol. The primary prognostic outcome was all-cause mortality at three years. Secondary endpoints comprised of a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhthmias, sudden cardiac death) and cardiac rehospitalization. Kaplan Meier survival curves and multivariable Cox regression analyses were applied for statistics.
Results:
1,098 patients were included, 80% treated with metoprolol and 20% with carvedilol. Patients with carvedilol were older, more often presented with VT (78% vs. 62%; p=0.001) and with more advanced stages of heart failure. Treatment with carvedilol was associated with comparable all-cause mortality compared to metoprolol (20% vs. 16%, log rank p = 0.234; HR = 1.229; 95% CI 0.874 - 1.728; p = 0.235). However, secondary endpoints (i.e., composite endpoint: 32% vs. 17%; p = 0.001 and cardiac rehospitalization: 25% vs. 14%; p = 0.001) were more frequently observed in patients with carvedilol, which was still evident after multivariable adjustment.
Conclusion:
Carvedilol and metoprolol are associated with comparable all-cause mortality in patients with ventricular tachyarrhytmias, whereas risk of the composite endpoint and cardiac rehospitalization may be increased in patients on carvedilol therapy.

https://dgk.org/kongress_programme/ht2021/P517.htm