Propranolol therapy for ventricular arrhythmias 2 months after acute myocardial infarction

• Published in: The American journal of cardiology Vol. 46; no. 2; pp. 322 - 328
• Main Authors: Koppes, Gerald M., Beckmann, Charles H., Jones, Frederic G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.1980
• Subjects: Adult; Aged; Ambulatory Care; Arrhythmias, Cardiac - complications; Arrhythmias, Cardiac - drug therapy; Blood Pressure - drug effects; Dose-Response Relationship, Drug; Electrocardiography; Exercise Test; Female; Heart Rate - drug effects; Heart Ventricles - physiopathology; Humans; Male; Middle Aged; Myocardial Infarction - complications; Propranolol - therapeutic use; Time Factors
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(80)90079-X

Treatment of premature ventricular complexes with propranolol was studied in 32 patients 2 months after an uncomplicated acute myocardial infarction. All patients had more than 30 premature ventricular complexes/hour averaged over 24 hours, with bigeminy, couplets, multifocal complexes or ventricular tachycardia. Twenty-four hour ambulatory electrocardiographic monitoring and treadmill testing were performed during a control, a treatment and a second control period. The average dosage of propranolol was 160 mg daily. Treadmill testing and ambulatory electrocardiographic monitoring showed a significant decrease in complexity and frequency of premature ventricular complexes with propranolol treatment when the two control periods were compared (p < 0.01 for frequency). During treatment with propranolol 56 percent of patients had 70 percent or greater suppression and 13 (41 percent) had 90 percent or greater suppression of premature ventricular complexes; the median percent reduction was 80 percent. The frequency of premature ventricular complexes also decreased from the first to the second control period (p < 0.05). No patient died suddenly in the 6 month follow-up period. It is concluded that propranolol effectively suppresses premature ventricular complexes after acute myocardial infarction, reducing both frequency and complexity. No sudden death occurred in this high risk population with complex ventricular arrhythmias. Premature ventricular complexes did not tend to increase with time early after acute myocardial infarction in the patients treated with propranolol. Ambulatory electrocardiographic monitoring should be considered for routine evaluation of patients 3 to 8 weeks after acute myocardial infarction and should be followed by antiarrhythmic therapy when complex premature ventricular complexes are noted.