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Went TR, Sultan W, Sapkota A, Khurshid H, Qureshi IA, Jahan N, Tara A, Win M, Wiltshire DA, Kannan A, Ruo SW, Alfonso M. A Systematic Review on the Role of Βeta-Blockers in Reducing Cardiac Arrhythmias in Long QT Syndrome Subtypes 1-3. Cureus 2021; 13:e17632. [PMID: 34646680 PMCID: PMC8485362 DOI: 10.7759/cureus.17632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 12/12/2022] Open
Abstract
Long QT syndrome (LQTS) is one of the most common inherited cardiac channelopathies with a prevalence of 1:2000. The condition can be congenital or acquired with 15 recognized genotypes; the most common subtypes are LQTS 1, 2, and 3 making up to 85%-90% of the cases. LQTS is characterized by delayed ventricular cardiomyocyte repolarization manifesting on the surface electrocardiogram (EKG) by a prolonged corrected QT (QTc) interval. The mainstay of treatment for this condition involves in part or combination medical therapy via β-blockers as first-line (or other anti-arrhythmic), left cardiac sympathectomy, or implantable cardiac defibrillator placement. Given the high rate of adverse cardiac events (ACE) or sudden cardiac death (SCD) in this population of patients with this disease, this review seeks to highlight the genotype-specific treatment consensus in β-blocker therapy of the most common subtypes. A database search of PubMed, PMC, and Medline was conducted to ascertain the most recent data in the last five years on the management of LQTS types 1-3 and the role of β-blockers in reducing ACE in these types. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to in the study selection, and selected studies focused on humans, written in the English Language, and within the last five years of LQTS subtypes 1, 2, and 3. Eleven relevant studies were selected after considering inclusion criteria, exclusion criteria, and quality appraisal within the last five years, focusing on β-blocker selection directed based on the subtypes of LQTS. Two meta-analyses, one cohort study, and eight reviews provided significant data that non-selective β-blockers unequivocally are of benefit in these LQTS types. Summary of findings suggested nadolol followed by propranolol yields the best results in LQTS 1, while nadolol would yield the best effect in LQTS 2 and 3.
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Affiliation(s)
- Terry R Went
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Waleed Sultan
- Medicine, Beni Suef University Faculty of Medicine, Beni Suef, EGY
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Surgery, Halifax Health Medical Center, Daytona Beach, USA
| | - Alisha Sapkota
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Hajra Khurshid
- Medicine and Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Israa A Qureshi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nasrin Jahan
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anjli Tara
- General Medicine, General Surgery, and Emergency Department, Jinnah Postgraduate Medical Centre, Karachi, PAK
- Neurosurgery and General Surgery, Liaquat University of Medical and Health Sciences, Karachi, PAK
- Neurosurgery and General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Myat Win
- General Surgery, Nottingham University Hospitals NHS Trust, Nottingham, GBR
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dwayne A Wiltshire
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amudhan Kannan
- Neurological Surgery Research, Surgical Oncology Research, and General Surgery Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Surgical Pharmacology, General Surgery, and Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sheila W Ruo
- General Surgery Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Michael Alfonso
- Medicine, Universidad del Rosario, Bogota, COL
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Abstract
I mbalance of the sympathetic and parasympathetic nervous systems is probably the most prevalent autonomic mechanism underlying many a rrhythmias . Recently, vagus nerve stimulation ( VNS has emerged as a novel therapeutic modality to treat arrhythmias through its anti adrenergic and anti inflammatory actions . C linical trials applying VNS to the cervical vagus nerve in heart failure pati en ts yielded conflicting results, possibly due to limited understanding of the optimal stimulation parameters for the targeted cardiovascular diseases. Transcutaneous VNS by stimulating the auricular branch of the vagus nerve, has attracted great attention d ue to its noninvasiveness. In this r eview, we summarize current knowledge about the complex relationship between VNS and cardiac arrhythmias and discuss recent advances in using VNS , particularly transcutaneous VNS , to treat arrhythmias.
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Affiliation(s)
- Chengzhe Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiac Autonomic Nervous System Research Center of Wuhan Univer s ity, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiac Autonomic Nervous System Research Center of Wuhan Univer s ity, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiac Autonomic Nervous System Research Center of Wuhan Univer s ity, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Sunny S Po
- Heart Rhythm Institute and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, O K USA
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Thind M, Rodriguez I, Kosari S, Turner JR. How to Prescribe Drugs With an Identified Proarrhythmic Liability. J Clin Pharmacol 2019; 60:284-294. [DOI: 10.1002/jcph.1551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Munveer Thind
- Lankenau Institute for Medical Research Philadelphia Pennsylvania USA
| | - Ignacio Rodriguez
- Novartis Pharmaceutical Corporation East Hanover New Jersey USA
- Cardiac Safety Research Consortium Duke Clinical Research Institute Durham North Carolina USA
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health University of Canberra Bruce Australian Capital Territory Australia
| | - J. Rick Turner
- Cardiac Safety Research Consortium Duke Clinical Research Institute Durham North Carolina USA
- The American College of Clinical Pharmacology Rockville Maryland USA
- Department of Pharmacy Practice Campbell University College of Pharmacy & Health Sciences Buies Creek North Carolina USA
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