Effectiveness of Bisoprolol in Patients with Cardiac Arrhythmias – A Systematic Review of Studies

Introduction

Since 1965, when the first beta-blocker (propranolol) was introduced into clinical practice, more than 50 different representatives of this drug group have been used for the treatment of cardiac and non-cardiac diseases. They have long and successfully been administered for the treatment of both supraventricular and ventricular arrhythmias. Differences in the chemical structure, pharmacokinetics, and pharmacodynamics of individual BBs are important as they can reflect their distinct antiarrhythmic properties.

Bisoprolol is among the most commonly used BBs in clinical practice due to its favorable efficacy and safety profile. The CIBIS study demonstrated its ability to reduce mortality in patients with heart failure. It is also administered for the treatment of arterial hypertension and myocardial ischemia. However, its use in patients with arrhythmias is less common and is not included in European guidelines.

Included Studies

The authors reviewed the MEDLINE database using keywords "bisoprolol" + "arrhythmia" or "atrial fibrillation," "ventricular tachycardia," "premature ventricular complexes," and "ventricular fibrillation" to find publications up to April 2020 discussing the role of bisoprolol in the therapy of arrhythmias. The found data were analyzed based on the type of treated arrhythmia and the quality of evidence using the GRADE tool.

A total of 325 studies were found, out of which 28 were considered relevant to the topic: 19 evaluated the role of bisoprolol in the treatment of supraventricular arrhythmias, 8 in ventricular arrhythmias, and 1 in both. The quality of the evidence ranged from low (7 studies) to high (5 studies).

Findings

Regarding supraventricular arrhythmias:

• In the prevention of recurrences in patients with atrioventricular nodal re-entry tachycardia (AVNRT), bisoprolol is less effective than catheter ablation.
• In patients with atrial fibrillation, it is useful as part of a heart rate control strategy, effectively reducing it.
• In patients who have undergone cardiac or non-cardiac surgery, it is effective as part of a rhythm control strategy, preventing the onset of atrial fibrillation (AF).
• Less robust evidence confirms its role in the pharmacological cardioversion of AF, in the prevention of AF recurrence after electrical cardioversion, and in alleviating symptoms or improving the quality of life in patients with paroxysmal AF.

Regarding ventricular arrhythmias:

• Bisoprolol reduces mortality and effectively reduces the number of hospitalizations due to severe arrhythmias in patients with stable heart failure.
• When administered early (within 4 hours) after myocardial infarction (MI), it reduces mortality, the number of episodes of ventricular arrhythmias, and major adverse cardiac events (MACE) in patients with non-ST-elevation myocardial infarction (NSTEMI).
• It effectively reduces the burden of ventricular arrhythmia in patients with premature ventricular contractions (PVC).
• It is less established in the treatment of patients with long QT syndrome (LQTS).

Conclusion

The authors of the reviewed study conclude that current evidence supports the use of bisoprolol in the treatment of supraventricular arrhythmias, particularly for heart rate control in atrial fibrillation. Evidence also demonstrates its efficacy in ventricular arrhythmias, both in primary and secondary prevention. To better understand the position of bisoprolol in the treatment of arrhythmias among other beta-blockers, the authors recommend clinical studies directly comparing effective substances (head-to-head) in terms of efficacy and safety conducted on large patient populations.

(esr)

Source: Muresan L., Cismaru G., Muresan C. et al. Beta-blockers for the treatment of arrhythmias: bisoprolol – a systematic review. Ann Pharm Fr 2022; 80 (5): 617–634, doi: 10.1016/j.pharma.2022.01.007.