COMBINATION OF CELIPROLOL AND AMIODARONE IN THE TREATMENT OF RECURRENT VENTRICULAR-TACHYCARDIA

The combination of beta-blockers and amiodarone has been shown to be a ffective in the treatment of refractory chronic ventricular tachycardi a. However, the possible induction of excessive sinus bradycardia can constitute a limitation to the use of this treatment. Celiprolol is a cardioselective beta-blocker with a partial beta-2 agonist activity an d an alpha-2 blocking activity, with a minimal depressant effect on he art rate. It there fore seemed useful to evaluate this drug in combina tion with amiodarone in patients with chronic ventricular tachycardia refractory to amiodarone alone. Twelve men with age of 57 +/- 16 years (9 with a history of myocardial infarction) received 200 mg of celipr olol per day associated with an average of 2 grams of amiodarone per w eek. Failure of oral amiodarone alone was confirmed by ''reloading'' ( 1200 mg per day for 4 days) in 11 patients. The mean left ventricular ejection fraction was 36 +/- 19%, and was less than or equal to 30% in 5 patients. Three patients were classified as stage 3-4 of the NYHA f unctional classification. Episodes of tachycardia were paroxysmal in 1 0 patients and diurnal in 10 cases. The effects of treatment were eval uated by clinical examination, continuous electrocardiographic monitor ing, stress test and endocavitary electrophysiological investigation. No patient developed cardiac decompensation or collapse during beta-bl ocker treatment. In one case, the dose of celiprolol had to be decreas ed to 100 mg per day because of hypotension. No proarrhythmic effect w as observed. The sinus rate remained unchanged after addition of celip rolol to amiodarone (57 +/- 3 bpm before versus 56 +/- 4 bpm after). O n the stress test, the exercise capacity was maintened and no tachyarr hythmia was induced. Right ventricular refractory periods were not mod ified by celiprolol (mean effective period 289 +/- 20 ms before versus 294 +/- 20 ms after). Following a hospital stay of 17 +/- 7 days, the beta-blocker was discontinued in 5 patients because of persistence of permanent tachycardia in 1 case, and because of inducibility of a tac hycardia with the same frequency as before treatment in the other 4 ca ses. No sudden death or haemodynamically unstable recurrence of ventri cular tachycardia were observed during follow-up over a period of 38 /- 24 months (range: 2-55) of the 7 patients in whom treatment was con sidered to be effective. Only one patient presented a temporary and re versible deterioration of heart failure. The absence of excessive brad ycardia was also observed during follow-up. In one patient, celiprolol was replaced by another antiarrhythmic due to the recrudescence of in ducibility to programmed stimulation. Three patients developed a spont aneous recurrence of sustained monomorphie ventricular tachycardia, wh ich was well tolerated. In conclusion, these results suggest that celi prolol in combination with amiodarone in the treatment of refractory c hronic ventricular tachycardia is a valuable therapeutic option becaus e of its good inotropic and particularly chronotropic safety. However, the efficacy of treatment must be evaluated by a stress test and by e ndocavitary electrophysiological investigation including programmed ve ntricular stimulation in every case.