Propranolol found superior to Metoprolol for electrical storm
Propranolol found superior to Metoprolol for electrical storm: Use of propranolol has gone down with the availability of newer beta blockers. Here is one study which suggests that we may have to go back to propranolol in certain situations. The study by Chatzidou S et al  has found that propranolol is superior to metoprolol in the treatment of electrical storm along with intravenous amiodarone. Propranolol has a membrane stabilizing effect (local anaesthetic effect), which is not there for metoprolol. Of course metoprolol is beta one specific and has other advantages which propranolol does not have, being a non selective beta blocker.
The study titled ‘Propranolol Versus Metoprolol for Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillator’ published in the Journal of American College of Cardiology studied 60 patients (45 men, with a mean age of 65 +/- 8.5 years) in whom electrical storm was noted in the presence of an implantable cardioverter defibrillator (ICD). Intravenous amiodarone for 48 hours was combined with propranolol 160 mg/day or metoprolol 200 mg/day in a randomized study. The study period was between 2011 and 2016. Those treated with propranolol had 2.67 times lower incidence of ventricular arrhythmic events (ventricular tachycardia or fibrillation) and 2.34 times decreased rates of ICD discharges during intensive care stay, after adjusting for multiple confounding factors. More likelihood of arrhythmia termination, shorter time to arrhythmia termination and length of hospital stay were noted with propranolol.
So is it time to go back to propranolol when you are concerned about ventricular arrhythmias?
- Chatzidou S, Kontogiannis C, Tsilimigras D Georgiopoulos G, Kosmopoulos M, Papadopoulou E, Vasilopoulos G, Rokas S. Propranolol Versus Metoprolol for Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillator. J Am Coll Cardiol. 2018 May 1;71(17):1897-1906. J Am Coll Cardiol. 2018;71(17):1897-1906.