Assessment of a novel transdermal selective β1-blocker, the bisoprolol patch, for treating frequent premature ventricular contractions in patients without structural heart disease.
BACKGROUND
The autonomic nervous system involves the genesis of premature ventricular contractions (PVCs). Previous studies demonstrated that heart rate (HR) dependency of idiopathic PVCs has different autonomic mechanisms. Recently, the bisoprolol patch, a novel transdermal β1-blocker formulation containing bisoprolol, became clinically available. We examined the efficacy of the bisoprolol patch for treating frequent PVCs in patients without structural heart disease (SHD) regarding the HR dependency of PVCs.


METHODS
This prospective study included 44 consecutive patients without SHD (25 men, mean age, 63.6±12.3 years) with PVC counts≥3000 beats as measured by 24-hour Holter electrocardiograms (ECGs). PVCs were divided into positive HR-dependent PVCs (P-PVCs) and non-positive HR-dependent PVCs (NP-PVCs) based on the relationship between the hourly PVC density and hourly mean HR. A bisoprolol patch was administered once daily at a dose of 4mg. The 24-hour Holter ECGs were performed before and 1 month after the initiation of the therapy.


RESULTS
In 44 patients, there were 24 P-PVCs and 20 NP-PVCs. The bisoprolol patch reduced the PVC count significantly (from 16,563±10,056 to 7892±8817 beats/24hours, p<0.001) in the P-PVC group, while the PVC count did not change significantly (from 16,409±9571 to 13,476±12,191beats/24hours, p=0.34) in the NP-PVC group. Moreover, in the P-PVC group, the patients with mean HRs ≥80 beats/minute had a significantly higher percent improvement in the PVC count than those with mean HRs <80 beats/minute (p=0.0080). The bisoprolol patch resulted in a significant reduction in the PVC count from baseline during each time period for the changes within a 24-hour period in the P-PVC group.


CONCLUSIONS
The transdermal bisoprolol patch was effective for a PVC reduction in patients with P-PVCs, particularly in those with faster mean HRs. Furthermore, it demonstrated a stable PVC-reducing effect during the 24-hour period in the P-PVC group.
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan. Electronic address: qq5v7trd@ray.ocn.ne.jp.
Masaya
M
Shinohara
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Tadashi
T
Fujino
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Hideki
H
Koike
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Ken
K
Kitahara
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Toshio
T
Kinoshita
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Hitomi
H
Yuzawa
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Takeya
T
Suzuki
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Shunji
S
Fukunaga
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Kenzaburo
K
Kobayashi
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Jiro
J
Aoki
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Kengo
K
Tanabe
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Takanori
T
Ikeda
D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000368:Aged; D017298:Bisoprolol / Q000008:administration & dosage* / Q000627:therapeutic use; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D057968:Transdermal Patch; D018879:Ventricular Premature Complexes / Q000188:drug therapy* / Q000503:physiopathology
D058671:Adrenergic beta-1 Receptor Antagonists; D017298:Bisoprolol
Bisoprolol patch; Heart rate; Premature ventricular contractions; Selective β1-blocker; Transdermal medicine