Antiarrhythmic effect of carvedilol after acute myocardial infarction: results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial.

Abstract

OBJECTIVES:

Whether beta-blockers reduce atrial arrhythmias and, when added to an angiotensin-converting enzyme (ACE) inhibitor, ventricular arrhythmia is unknown.

BACKGROUND:

Ventricular and atrial arrhythmias are common after acute myocardial infarction (AMI) and are associated with a poor prognosis. Angiotensin-converting enzyme inhibitors reduce the incidence of both types of arrhythmia.

METHODS:

The antiarrhythmic effect of carvedilol was examined in a placebo-controlled multicenter trial, the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) study, which enrolled 1,959 patients with reduced left ventricular systolic function after AMI, 98% of whom were treated with an ACE inhibitor.

RESULTS:

The incidence of atrial fibrillation/flutter was 53 to 984 (5.4%) in the placebo group and 22 to 975 (2.3%) in the carvedilol group, giving a carvedilol/placebo hazard ratio (HR) of 0.41 (95% confidence interval [CI] 0.25 to 0.68; p = 0.0003). The corresponding rates of ventricular tachycardia/flutter/fibrillation were 38 to 984 (3.9%) and 9 to 975 (0.9%) (HR 0.24, 95% CI 0.11 to 0.49; p < 0.0001).

CONCLUSIONS:

Carvedilol has a powerful antiarrhythmic effect after AMI, even in patients already treated with an ACE inhibitor. Carvedilol suppresses atrial as well as ventricular arrhythmias in these patients.

• Authors: John McMurray, Lars Køber, Michele Robertson, Henry Dargie, Wilson Colucci, Jose Lopez-Sendon, Willem Remme, D Norman Sharpe, Ian Ford
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 45 Issue 4 Pg. 525-30 (Feb 15 2005) ISSN: 0735-1097 [Print] United States
• PMID: 15708698 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic beta-Antagonists
• Carbazoles
• Propanolamines
• Carvedilol

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Adult
• Aged
• Aged, 80 and over
• Arrhythmias, Cardiac (etiology, prevention & control)
• Carbazoles (therapeutic use)
• Carvedilol
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (complications)
• Propanolamines (therapeutic use)
• Prospective Studies