An International Multicenter Cohort Study on β-Blockers for the Treatment of Symptomatic Children With Catecholaminergic Polymorphic Ventricular Tachycardia.

Adolescent Adrenergic beta-Antagonists / pharmacology Child Cohort Studies Female Humans Male Tachycardia, Ventricular / drug therapy
atenolol child death, sudden, cardiac metoprolol nadolol polymorphic catecholergic ventricular tachycardia propranolol

Journal

Circulation
ISSN: 1524-4539
Titre abrégé: Circulation
Pays: United States
ID NLM: 0147763

Informations de publication

Date de publication:
02 2022
Historique:
pubmed: 8 12 2021
medline: 23 2 2022
entrez: 7 12 2021
Statut: ppublish

Résumé

Symptomatic children with catecholaminergic polymorphic ventricular tachycardia (CPVT) are at risk for recurrent arrhythmic events. β-Blockers decrease this risk, but studies comparing individual β-blockers in sizeable cohorts are lacking. We aimed to assess the association between risk for arrhythmic events and type of β-blocker in a large cohort of symptomatic children with CPVT. From 2 international registries of patients with CPVT, We included 329 patients (median age at diagnosis, 12 [interquartile range, 7-15] years, 35% females). Ninety-nine (30.1%) patients experienced the primary outcome and 74 (22.5%) experienced the secondary outcome during a median follow-up of 6.7 (interquartile range, 2.8-12.5) years. Two-hundred sixteen patients (66.0%) used a nonselective β-blocker (predominantly nadolol [n=140] or propranolol [n=70]) and 111 (33.7%) used a β1-selective β-blocker (predominantly atenolol [n=51], metoprolol [n=33], or bisoprolol [n=19]) as initial β-blocker. Baseline characteristics did not differ. The HRs for both the primary and secondary outcomes were higher for β1-selective compared with nonselective β-blockers (HR, 2.04 [95% CI, 1.31-3.17]; and HR, 1.99 [95% CI, 1.20-3.30], respectively). When assessed separately, the HR for the primary outcome was higher for atenolol (HR, 2.68 [95% CI, 1.44-4.99]), bisoprolol (HR, 3.24 [95% CI, 1.47-7.18]), and metoprolol (HR, 2.18 [95% CI, 1.08-4.40]) compared with nadolol, but did not differ from propranolol. The HR of the secondary outcome was only higher in atenolol compared with nadolol (HR, 2.68 [95% CI, 1.30-5.55]). β1-selective β-blockers were associated with a significantly higher risk for arrhythmic events in symptomatic children with CPVT compared with nonselective β-blockers, specifically nadolol. Nadolol, or propranolol if nadolol is unavailable, should be the preferred β-blocker for treating symptomatic children with CPVT.

Sections du résumé

BACKGROUND
Symptomatic children with catecholaminergic polymorphic ventricular tachycardia (CPVT) are at risk for recurrent arrhythmic events. β-Blockers decrease this risk, but studies comparing individual β-blockers in sizeable cohorts are lacking. We aimed to assess the association between risk for arrhythmic events and type of β-blocker in a large cohort of symptomatic children with CPVT.
METHODS
From 2 international registries of patients with CPVT,
RESULTS
We included 329 patients (median age at diagnosis, 12 [interquartile range, 7-15] years, 35% females). Ninety-nine (30.1%) patients experienced the primary outcome and 74 (22.5%) experienced the secondary outcome during a median follow-up of 6.7 (interquartile range, 2.8-12.5) years. Two-hundred sixteen patients (66.0%) used a nonselective β-blocker (predominantly nadolol [n=140] or propranolol [n=70]) and 111 (33.7%) used a β1-selective β-blocker (predominantly atenolol [n=51], metoprolol [n=33], or bisoprolol [n=19]) as initial β-blocker. Baseline characteristics did not differ. The HRs for both the primary and secondary outcomes were higher for β1-selective compared with nonselective β-blockers (HR, 2.04 [95% CI, 1.31-3.17]; and HR, 1.99 [95% CI, 1.20-3.30], respectively). When assessed separately, the HR for the primary outcome was higher for atenolol (HR, 2.68 [95% CI, 1.44-4.99]), bisoprolol (HR, 3.24 [95% CI, 1.47-7.18]), and metoprolol (HR, 2.18 [95% CI, 1.08-4.40]) compared with nadolol, but did not differ from propranolol. The HR of the secondary outcome was only higher in atenolol compared with nadolol (HR, 2.68 [95% CI, 1.30-5.55]).
CONCLUSIONS
β1-selective β-blockers were associated with a significantly higher risk for arrhythmic events in symptomatic children with CPVT compared with nonselective β-blockers, specifically nadolol. Nadolol, or propranolol if nadolol is unavailable, should be the preferred β-blocker for treating symptomatic children with CPVT.

Identifiants

DOI: 10.1161/CIRCULATIONAHA.121.056018 PMID: 34874747
pubmed: 34874747
doi: 10.1161/CIRCULATIONAHA.121.056018
doi:

Substances chimiques

Adrenergic beta-Antagonists 0

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

333-344

Subventions

Organisme : Canadian Institute of Health Research
ID : RN380020–406814

Auteurs

Puck J Peltenburg (PJ)

Amsterdam UMC, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, The Netherlands (P.J.P., K.V.V.L., M.T., C.v.d.W., A.A.M.W.).
Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, The Netherlands (P.J.P., S.-A.B.C., N.A.B.).
ORCID: 0000-0002-8942-164X

Dania Kallas (D)

BC Children's Hospital, Vancouver, Canada. Department of Pediatrics (D.K., S.F., T.M.R., S.S.), University of British Columbia, Vancouver, Canada.

Johan M Bos (JM)

Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Division of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (J.M.B., K.B.S., J.R.G., M.J.A.).
ORCID: 0000-0002-3635-2003

Krystien V V Lieve (KVV)

Amsterdam UMC, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, The Netherlands (P.J.P., K.V.V.L., M.T., C.v.d.W., A.A.M.W.).

Sonia Franciosi (S)

BC Children's Hospital, Vancouver, Canada. Department of Pediatrics (D.K., S.F., T.M.R., S.S.), University of British Columbia, Vancouver, Canada.

Thomas M Roston (TM)

BC Children's Hospital, Vancouver, Canada. Department of Pediatrics (D.K., S.F., T.M.R., S.S.), University of British Columbia, Vancouver, Canada.
Center for Cardiovascular Innovation, Division of Cardiology (T.M.R., A.D.K.), University of British Columbia, Vancouver, Canada.
ORCID: 0000-0001-5663-4377

Isabelle Denjoy (I)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
ORCID: 0000-0002-1786-9461

Katrina B Sorensen (KB)

Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Division of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (J.M.B., K.B.S., J.R.G., M.J.A.).
ORCID: 0000-0002-6087-0484

Seiko Ohno (S)

Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan (S.O., K.K., M.H.), National Cerebral and Cardiovascular Centre, Suita, Japan.
ORCID: 0000-0003-1209-8896

Ferran Roses-Noguer (F)

Department of Cardiology, Royal Brompton Hospital, London, UK (F.R.-N., J.T.).
ORCID: 0000-0002-5955-7490

Takeshi Aiba (T)

Department of Bioscience and Genetics (S.O.), Department of Cardiovascular Medicine (T.A., W.S.), National Cerebral and Cardiovascular Centre, Suita, Japan.
ORCID: 0000-0003-1779-7282

Alice Maltret (A)

Amsterdam UMC, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, The Netherlands (P.J.P., K.V.V.L., M.T., C.v.d.W., A.A.M.W.).

Martin J LaPage (MJ)

Department of Pediatrics, Division of Cardiology; University of Michigan, Ann Arbor (M.J.L.).
ORCID: 0000-0002-5694-6570

Joseph Atallah (J)

Cardiology, Faculty of Medicine & Dentistry: Pediatrics Department, Stollery Children's Hospital, Edmonton, Canada (J.A.).
ORCID: 0000-0001-8763-2067

John R Giudicessi (JR)

Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Division of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (J.M.B., K.B.S., J.R.G., M.J.A.).
ORCID: 0000-0001-5871-0265

Sally-Ann B Clur (SB)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, The Netherlands (P.J.P., S.-A.B.C., N.A.B.).
ORCID: 0000-0001-5276-1475

Nico A Blom (NA)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, The Netherlands (P.J.P., S.-A.B.C., N.A.B.).
Department of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, The Netherlands (N.A.B.).

Michael Tanck (M)

Amsterdam UMC, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, The Netherlands (P.J.P., K.V.V.L., M.T., C.v.d.W., A.A.M.W.).
ORCID: 0000-0001-9828-4459

Fabrice Extramiana (F)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
ORCID: 0000-0001-8123-4842

Koichi Kato (K)

Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan (S.O., K.K., M.H.), National Cerebral and Cardiovascular Centre, Suita, Japan.
ORCID: 0000-0002-6125-0789

Julien Barc (J)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
Université de Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France (J.B.).
ORCID: 0000-0003-4106-5946

Martin Borggrefe (M)

Université de Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France (J.B.).
Department of Medicine, University Medical Center Mannheim, Germany (M.B.).

Elijah R Behr (ER)

German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim (M.B.).
ORCID: 0000-0002-8731-2853

Georgia Sarquella-Brugada (G)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Spain; Medical Science Department, School of Medicine, Universitat de Girona, Spain (G.S.-B.).

Jacob Tfelt-Hansen (J)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (J.T.-H.).
Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark (J.T.-H.).
ORCID: 0000-0003-3895-9316

Esther Zorio (E)

Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain (E.Z.).
Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), Madrid, Spain (E.Z.).
ORCID: 0000-0003-3608-4210

Heikki Swan (H)

Heart and Lung Centre, Helsinki University Hospital and Helsinki University, Finland (H.S.).

Janneke A E Kammeraad (JAE)

Department of Pediatric Cardiology, Erasmus MC - Sophia, Rotterdam, The Netherlands (J.A.E.K.).

Andrew D Krahn (AD)

Center for Cardiovascular Innovation, Division of Cardiology (T.M.R., A.D.K.), University of British Columbia, Vancouver, Canada.
ORCID: 0000-0002-7982-1586

Andrew Davis (A)

The Royal Children's Hospital, Melbourne, Australia (A.D.).
Murdoch Children's Research Institute and Department of Paediatrics, Melbourne University, Australia (A.D.).
ORCID: 0000-0003-2826-8562

Frederic Sacher (F)

LIRYC Institute, Bordeaux University Hospital, Bordeaux University, France (F.S.).
ORCID: 0000-0001-8348-9320

Peter J Schwartz (PJ)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy (P.J.S.).
ORCID: 0000-0003-0367-1048

Jason D Roberts (JD)

Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (J.D.R.).
Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada (J.D.R.).
ORCID: 0000-0003-0268-6723

Jonathan R Skinner (JR)

Cardiac Inherited Disease Group New Zealand, Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand (J.R.S.).
Department of Paediatrics Child and Youth Health, The University of Auckland, New Zealand (J.R.S.).
ORCID: 0000-0002-3653-0412

Maarten P van den Berg (MP)

Department of Cardiology, University of Groningen, University Medical Centre Groningen, The Netherlands (M.P.v.d.B).
ORCID: 0000-0002-1493-2998

Prince J Kannankeril (PJ)

Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Centre, Nashville, TN (P.J.K.).
ORCID: 0000-0002-1529-9872

Fabrizio Drago (F)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Palidoro-Rome, Italy (F.D.).
ORCID: 0000-0003-1888-373X

Tomas Robyns (T)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (T.R.).
Department of Cardiovascular Sciences, University of Leuven, Belgium (T.R.).
ORCID: 0000-0002-8676-4874

Kristina Haugaa (K)

Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Norway (K.H.).
University of Oslo, Norway (K.H.).
ORCID: 0000-0002-4900-0453

Terezia Tavacova (T)

Department of Pediatric Cardiology, Children's Heart Centre, Second Faculty of Medicine, Charles University in Prague, Czech Republic (T.T.).
Motol University Hospital, Prague, Czech Republic (T.T.).
ORCID: 0000-0002-0699-8284

Christopher Semsarian (C)

Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Australia (C.S.).
Faculty of Medicine and Health, The University of Sydney, Australia (C.S.).
ORCID: 0000-0001-6441-274X

Jan Till (J)

Department of Cardiology, Royal Brompton Hospital, London, UK (F.R.-N., J.T.).

Vincent Probst (V)

Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (V.B.).
ORCID: 0000-0002-5492-8619

Ramon Brugada (R)

Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.B.).
Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), University of Girona, Spain (R.B.).
Medical Science Department, School of Medicine, University of Girona, Spain (R.B.).
Cardiology Service, Hospital Josep Trueta, Girona, Spain (R.B.).
ORCID: 0000-0001-6607-3032

Wataru Shimizu (W)

Department of Bioscience and Genetics (S.O.), Department of Cardiovascular Medicine (T.A., W.S.), National Cerebral and Cardiovascular Centre, Suita, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
ORCID: 0000-0001-9941-8973

Minoru Horie (M)

Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan (S.O., K.K., M.H.), National Cerebral and Cardiovascular Centre, Suita, Japan.
ORCID: 0000-0002-9029-2339

Antoine Leenhardt (A)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
ORCID: 0000-0001-7368-4528

Michael J Ackerman (MJ)

Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Division of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (J.M.B., K.B.S., J.R.G., M.J.A.).
ORCID: 0000-0002-8011-3333

Shubhayan Sanatani (S)

BC Children's Hospital, Vancouver, Canada. Department of Pediatrics (D.K., S.F., T.M.R., S.S.), University of British Columbia, Vancouver, Canada.
ORCID: 0000-0001-9296-7400

Christian van der Werf (C)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).

Arthur A M Wilde (AAM)

Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (ERN GUARDHEART; http://guardheart.ern-net.eu; I.D., S.-A.B.C., N.A.B., F.E., J.B., G.S.-B., J.T.-H., P.J.S., F.D., T.R., V.B., A.L., C.v.d.W., A.A.M.W.).
ORCID: 0000-0002-0528-0852

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › An International Multicenter Cohort Study on...
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questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Troubles du rythme cardiaque › Tachycardie › Tachycardie ventriculaire › An International Multicenter Cohort Study on...