Cdock forever trial5/15/2023 ![]() ![]() ![]() The mechanism underlying the favorable antiarrhythmic effect of carvedilol remains unclear. Overall, 72% of patients showed a decrease in PVC, and the average reduced burden of PVC compared to baseline was 71.5% ± 32.3%. In this cohort of 25 patients with OT PVC, carvedilol treatment significantly reduced the PVC burden. A P value < 0.05 was considered statistically significant. All statistical analyses were performed by the MedCalc statistical software version 19.1.7 (MedCalc Software Ltd, Ostend, Belgium). For categorical variables, the Chi-square test was used. To compare the continuous variables, paired or independent sample t test was performed. Categorical variables are expressed as numbers and percentages. The median and interquartile range were used for continuous variables that did not follow a normal distribution. Statistical analysisĬontinuous variables are expressed as the mean value ± standard deviation. Clinical, electrocardiographic, and Holter monitoring studies were reviewed and analyzed. Of these, patients treated with carvedilol and who underwent Holter monitoring before and after treatment were identified. The OT PVC was defined as PVC showing a tall R wave in II/III/aVF lead in the 12-lead electrocardiogram. A manual chart review was performed on this subset of patients to identify those who were prescribed carvedilol for the treatment of OT PVC. Patients who had a diagnosis of “ventricular premature complex (I49.3 in ICD-10)” were retrospectively identified by systematic screening of the Keimyung University Dongsan Hospital electronic medical records review. The purpose of this study was to evaluate the effect of carvedilol on patients with OT PVC as a retrospective study and to obtain basic data for the future prospective randomized study. Therefore, the OT PVC often requires treatment. The OT PVCs associated with disruptive symptoms and frequent OT PVCs can lead to cardiomyopathy. Premature ventricular complex (PVC) occurring in the ventricular outflow tract (OT) is the most common arrhythmia among the idiopathic ventricular arrhythmias (VAs), and its mechanism is related to intracellular calcium overload and delayed afterdepolarizations that leads to triggered activity. Among various beta-blockers, only carvedilol is known to be a drug that can directly inhibit the release of SOICR along with the beta-blockade effect. The SOICR may cause significant arrhythmia by the triggered activity, which is induced by activating the Na +/Ca 2+ exchanger. ![]() Recently, inhibition of store overload-induced calcium release (SOICR) has been suggested as an antiarrhythmic effect of carvedilol. Antioxidative and alpha-blockade effects, along with nonselective beta-blockade, have been proposed, but the exact mechanism is still unknown. Now, we are conducting a prospective, randomized, multicenter study to evaluate the effect of carvedilol on OT PVC (Clinical trial registration: FOREVER trial, : NCT03587558).Ĭarvedilol is one of the most effective beta-blockers to reduce ventricular arrhythmia and mortality in patients with heart failure. In this retrospective pilot study, treatment with carvedilol showed PVC suppression in 72% of patients. There was no difference in age, carvedilol dose, duration of treatment, ventricular function, and left atrial size between responding and non-responding groups. The mean age of the patients was 54.9 ± 13.9 years, and the mean dose of carvedilol was 18.2 ± 10.2 mg (sustained release formulation, 8/16/32 mg). ResultsĪ total of 25 patients who underwent Holter monitoring before and after carvedilol administration were found and enrolled. Clinical, electrocardiographic, and Holter monitoring studies were reviewed. The electronic medical records at our hospital were screened to identify OT PVC patients treated with carvedilol. We evaluate the efficacy of carvedilol to suppress the OT PVC. Premature ventricular complex (PVC) originating from the ventricular outflow tract (OT) is the most common form of idiopathic PVC, and its main mechanism is related to triggered activity. One of the possible antiarrhythmic mechanisms of carvedilol is the suppression of store overload-induced Ca 2+ release, especially for the triggered activity. ![]() Carvedilol is one of the most effective beta-blockers in reducing ventricular tachyarrhythmias and mortality in patients with heart failure. ![]()
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