title: β1-Adrenoceptor blocker aggravated ventricular arrhythmia.
abstract: OBJECTIVE
  To assess the impact of β1 -adrenoceptor blockers (β1 -blocker) and isoprenaline on the incidence of idiopathic repetitive ventricular arrhythmia that apparently decreases with preprocedural anxiety.
  
  
  METHODS
  From January 2010 to July 2012, six patients were identified who had idiopathic ventricular arrhythmias that apparently decreased (by greater than 90%) with preprocedural anxiety. The number of ectopic ventricular beats per hour (VPH) was calculated from Holter or telemetry monitoring to assess the ectopic burden. The mean VPH of 24 hours from Holter before admission (VPH-m) was used as baseline (100%) for normalization. β1 -Blockers, isoprenaline, and/or aminophylline were administrated successively on the ward and catheter lab to evaluate their effects on the ventricular arrhythmias.
  
  
  RESULTS
  Among 97 consecutive patients with idiopathic ventricular arrhythmias, six had reduction in normalized VPHs in the hour before the scheduled procedure time from (104.6 ± 4.6%) to (2.8 ± 1.6%) possibly due to preprocedural anxiety (P < 0.05), then increased to (97.9 ± 9.7%) during β1 -blocker administration (P < 0.05), then quickly reduced to (1.6 ± 1.0%) during subsequent isoprenaline infusion. Repeated β1 -blocker quickly counteracted the inhibitory effect of isoprenaline, and VPHs increased to (120.9 ± 2.4%) from (1.6 ± 1.0%; P < 0.05). Isoprenaline and β1 -blocker showed similar effects on the arrhythmias in catheter lab.
  
  
  CONCLUSIONS
  In some patients with structurally normal heart and ventricular arrhythmias there is a marked reduction of arrhythmias associated with preprocedural anxiety. These patients exhibit a reproducible sequence of β1 -blocker aggravation and catecholamine inhibition of ventricular arrhythmias, including both repetitive ventricular premature beats and monomorphic ventricular tachycardia.
authors.affiliation: Cardivascular Division, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Dimpi
authors.initials: D
authors.lastname: Patel
authors.forename: Dao Wu
authors.initials: DW
authors.lastname: Wang
authors.forename: Jiang Tao
authors.initials: JT
authors.lastname: Yan
authors.forename: Henry H
authors.initials: HH
authors.lastname: Hsia
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: Chun Xia
authors.initials: CX
authors.lastname: Zhao
authors.forename: Hou Juan
authors.initials: HJ
authors.lastname: Zuo
authors.forename: Dao Wen
authors.initials: DW
authors.lastname: Wang
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000628:Aminophylline / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007545:Isoproterenol / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D058915:Purinergic P1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D017180:Tachycardia, Ventricular / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D000318:Adrenergic beta-Agonists; D058915:Purinergic P1 Receptor Antagonists; D000628:Aminophylline; D007545:Isoproterenol
keywords: isoprenaline; monomorphic ventricular tachycardia; ventricular premature beat; β1-adrenoceptor blocker