Effect of nesiritide (B-type natriuretic peptide) and dobutamine on ventricular arrhythmias in the treatment of patients with acutely decompensated congestive heart failure: the PRECEDENT study.
BACKGROUND
Dobutamine is commonly used as a means of treating decompensated congestive heart failure (CHF). Although typically effective at improving short-term hemodynamics and symptomatology, the frequent occurrence of arrhythmias and tachycardia is undesirable. In this randomized, multicenter trial, we compared the safety and clinical effectiveness of the cardiac hormone nesiritide (human B-type natriuretic peptide) with dobutamine in hospitalized patients with decompensated CHF.


METHODS
The study population consisted of 255 patients who were randomized to 1 of 2 doses of intravenous nesiritide (0.015 or 0.03 microg/kg/min) or dobutamine (> or =5 microg/kg/min) and stratified by means of an earlier history of ventricular tachycardia. Patients were also assessed with 24 hour Holter recordings immediately before and during study drug therapy and by means of signs and symptoms of CHF.


RESULTS
Dobutamine significantly increased the mean (1) number of ventricular tachycardia events per 24 hours by 48 +/- 205 (P =.001), (2) repetitive ventricular beats per hour by 15 +/- 53 (P =.001), (3) premature ventricular beats per hour by 69 +/- 214 (P =.006), and (4) heart rate by 5.1 +/- 7.7 beats per minute (P <.001). These end points were significantly decreased or unchanged in the nesiritide groups. Nesiritide did not increase heart rate, despite a greater reduction of blood pressure. Both drugs were similarly effective means of improving signs and symptoms of CHF.


CONCLUSIONS
Dobutamine is associated with substantial proarrhythmic and chronotropic effects in patients with decompensated CHF, whereas nesiritide actually reduces ventricular ectopy or has a neutral effect. Compared with dobutamine, nesiritide may be a safer, short-term treatment for patients with decompensated CHF.
Burger
Andrew J
AJ
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass 02215, USA. aburger@caregroup.harvard.edu
Horton
Darlene P
DP
LeJemtel
Thierry
T
Ghali
Jalal K
JK
Torre
Guillermo
G
Dennish
George
G
Koren
Michael
M
Dinerman
Jay
J
Silver
Marc
M
Cheng
Mei L
ML
Elkayam
Uri
U
D000368:Aged; D002316:Cardiotonic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004280:Dobutamine / Q000494:pharmacology / Q000627:therapeutic use*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000188:drug therapy*
D002316:Cardiotonic Agents; D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain; D004280:Dobutamine