Comparative efficacy of Bisoprolol and Nadolol in Long QT Syndrome and its implications for cardiovascular care in resource-limited countries: A meta-analysis

Tóm tắt

Background

Congenital Long QT Syndrome (LQTS) is a hereditary cardiac disorder characterized by delayed electrical conduction in cardiac cells, resulting in a prolonged QT interval on electrocardiography (ECG). It is mostly caused by disfunction of voltage-gated potassium channels, and in some rare types, by structural and functional changes of sodium channel in cardiac cells. This condition affects approximately 1 in 2000 individuals and is a major cause of sudden death in young people.

Currently, beta-blockers, specifically propranolol and nadolol, are the preferred initial treatments for LQTS. However, in some regions, access to these medications may be limited. Hence, this systematic review and meta-analysis aim to investigate the efficacy of bisoprolol, a more widely available beta-blocker, as a potential alternative treatment for Long QT Syndrome.

Methods

We conducted a comprehensive literature search using four electronic databases: PubMed, PMC, SCOPUS, and Embase, to ensure a thorough coverage of relevant studies. To enhance sensitivity, we used the keywords "bisoprolol" and "long QT syndrome" in our search strategy. Subsequently, all identified articles were screened manually by 2 independentreviewers to identify suitable references for inclusion in our meta-analysis.

Studies were included in this meta-analysis if (1) studies investigated the use of bisoprolol compared to any other beta blockers: atenolol, propranolol, nadolol and metoprolol; (2) long QT syndrome was diagnosed by clinical features and/or cardiac channel gene screening; (3) studies included patients with any genotype of congenital long QT syndrome; (4) studies used syncope, cardiac arrest and sudden cardiac death as cardiac events. Studies were excluded in this meta-analysis if (1) patients had cardiac comorbidity such as coronary syndromes, heart failure and congenital structural anomalies; (2) the datas were incomplete, (3) the article was not written in English.

Results

We included two cohort studies that investigated the use of bisoprolol compared to nadolol, the first line option for long QT syndrome (Table 1). Upon meta-analysis, we found no significant difference on the occurrence of syncope, cardiac arrest and sudden cardiac death between bisoprolol and nadolol group (RR: 0.70 (0.34-1.45) (Figure 1).

Conclusion

These findings indicate that bisoprolol may be an appropriate drug option for individuals with LQTS, particularly in regions where access to propranolol and nadolol is limited. However, considering the limited number of studies included in this analysis, more research has to be conducted, not just to assess its’ efficacy, but also the possible adverse effects, since bisoprolol is a more cardioselective beta-blocker compared to nadolol.