Impact of carvedilol versus metoprolol on ventricular arrhythmia burden and ICD therapies: a systematic review and meta-analysis.

摘要

BACKGROUND: Ventricular arrhythmias (VA) are major causes of morbidity and mortality in patients with cardiovascular disease. Implantable cardioverter-defibrillators (ICDs) are commonly used to prevent sudden cardiac death. However, patients with ICDs frequently experience recurrent arrhythmias and inappropriate shocks, which impact quality of life. Beta-blockers, specifically carvedilol and metoprolol, are commonly prescribed in this context. This meta-analysis aims to compare the impact of both medications in this patient population. METHODS: Comprehensive literature search was conducted to identify relevant studies comparing carvedilol to metoprolol in patients with VA or ICDs. Study outcomes included all-cause mortality, recurrent VA, and inappropriate ICD shocks. Effect estimates are presented as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: Five independent study populations, reported across six publications, including 7,777 patients (5,138 on carvedilol, 2,639 on metoprolol) were analyzed. Carvedilol was associated with a significantly lower risk of inappropriate ICD shocks (HR = 0.66, 95% CI: 0.48-0.90, P = 0.009) and inappropriate anti-tachycardia pacing (HR = 0.67, 95% CI: 0.49-0.91, P = 0.01) compared with metoprolol. There were no significant differences between the two beta-blockers in recurrent ventricular tachyarrhythmias or all-cause mortality. CONCLUSION: Carvedilol may provide additional benefit over metoprolol in reducing inappropriate ICD therapies and anti-tachycardia pacing, while no significant differences were found in recurrent ventricular arrhythmias or all-cause mortality. These findings support consideration of carvedilol in patients with ICDs, but further research is warranted to guide optimal beta-blocker selection.