Epicardial vasospasm and concomitant ventricular tachycardia treated with Beta-1-specific Beta-blockade: a case series in support of nebivolol

TL;DR

This paper presents three cases where nebivolol, a specific beta-blocker, helped treat dangerous heart conditions caused by epicardial vasospasm.

Contribution

The study introduces nebivolol as a potential treatment for spasm-related ventricular arrhythmias when conventional therapies fail.

Findings

Nebivolol improved clinical stability in patients with spasm-related ventricular arrhythmias.

Beta-1-specific beta-blockade may reduce sympathetic activity linked to vasospasm and arrhythmias.

Conventional treatments showed poor effectiveness in these high-risk patients.

Abstract

Patients who experience ventricular tachycardia and cardiac arrest induced by epicardial vasospasm are at high risk for recurrent cardiac events. Conventional treatment includes calcium channel-blockade, long-acting nitrates, and the withdrawal of beta-blockade. These guidelines have not been proven effective in randomized controlled trials, and the evidence against beta-blockade is primarily anecdotal. Ongoing medical management in the setting of treatment failure is unclear, but abnormal sympathetic activity has been implicated in both spasm and ventricular arrhythmias.

We describe three patients with spasm-related ventricular arrhythmias and unacceptably poor response to conventional treatment. Clinical stability and asymptomatic status were achieved following the addition of nebivolol, a third-generation, lipophilic beta-1-specific beta-blocker.

Selective beta-blockade may represent a therapeutic option in patients with high-risk epicardial spasm and ventricular arrhythmias. Furthermore, the apparent success of nebivolol in this setting suggests that hyperactive sympathetic input may represent a causal or aggravating factor in spasm-associated ventricular arrhythmias.

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