Comparison of the occurrence of ventricular arrhythmias in patients with acutely decompensated congestive heart failure receiving dobutamine versus nesiritide therapy

Ventricular arrhythmias are common in patients with congestive heart failur e (CHF) and may be exacerbated by positive inotropic therapy. Because human B-type natriuretic peptide (nesiritide), an arterial and venodilator, inhi bits sympathetic activity, it may decrease the incidence of arrhythmias. Ou r investigation compares the arrhythmogenicity of dobutamine with nesiritid e. A total of 305 patients with decompensated CHF requiring intravenous vas oactive therapy were randomized to receive standard therapy (n = 102) or ne siritide (0.015 mug/kg/min [n = 103] or 0.030 mug/kg/min [n = 100]) to gain additional data on the relative safety and efficacy of nesiritide compared with standard parenteral care. Dobutamine was chosen as the standard care agent in 58 subjects. During study drug infusion, all patients had continuo us clinical hemodynamic and electrocardiographic monitoring, The dobutamine and nesiritide groups were similar with respect to baseline use of antiarr hythmic agents, including beta blockers. Serious arrhythmias and the incide nce of cardiac arrest were more common in patients who received dobutamine than in those taking nesiritide: sustained ventricular tachycardia, 4 (7%) versus 2 (1%), respectively (p = 0.014); nonsustained ventricular tachycard ia, 10 (17%) versus 23 (11%), respectively (p = 0.029); cardiac arrest, 3 ( 5%) versus 0, respectively (p = 0.011). We conclude that among patients wit h decompensated CHF for whom dobutamine is selected as standard therapy, th e incidence of serious ventricular arrhythmias and cardiac arrest is signif icantly greater than the incidence of these events inpatients randomized to nesiritide. (C) 2001 by Excerpta Medico, Inc.