Impact of Beta-blockers Use on Ventricular Arrhythmias and ICD Shocks in Patients on Long-Term Inotropic Therapy

Purpose Continuous infusion of inotropes is increasingly used in patients with end-stage heart failure who are being discharged from the hospital. However, Dobutamine and Milrinone are both known to be arrhythmogenic agents. Because Milrinone does not act through the beta-adrenergic system, it may allow for the cautious addition of beta-blockers (BB). We therefore sought to compare the impact of BB use is these patients on ventricular arrhythmias. Methods We retrospectively reviewed all patients who were discharged from our Institution on inotropes (used as a bridge to durable LVAD or transplant, as a bridge to recovery, or as a palliative measure). The cohort was stratified into 2 groups based on whether BB were added to the medical regimen. We compared the incidence of ventricular arrhythmias and ICD device therapy (defined as shock or anti-tachycardia pacing) between the 2 groups. Results Between 2010 and 2017, 349 patients were discharged on inotropes. Mean age was 61+14 years, 74% were men and 64% were African American. Most patients (330) were treated with Milrinone. BB were used in 195 (56%) of patients, whereas 154 (44%) did not receive these meds. There were no significant differences between the 2 groups in baseline socio-demographics, etiology of cardiomyopathy, CV comorbidities, or invasive hemodynamics. Patients on BB were more likely to receive an LVAD/transplant (49% vs. 41%) or be weaned off inotropes (12% vs. 4%), and less likely to transition to hospice care/death (37% vs 53%). Patients on BB were more likely to receive ACEI/ARB than those who were not on BB (67% vs. 47%, p Conclusion In heart failure patients who are discharged on inotropes, the use of BB appears to be associated with a lower incidence of sustained ventricular arrhythmias, ICD shocks or anti-tachycardia pacing. Prospective studies are warranted to confirm these findings.