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Do beta blockers really reduce SCD risk? If so, can I stay on them indeffinitely?

I don't think I have the money for ablation surgery, or if that would even work for me.  I definitely don't have the money for an ICD.  I figure I can just take beta blockers for the rest of my life and hope for the best.  That being said, I'm only 33 and If I'm lucky to live another 5, 10 or 15 years, that's a long time to take a drug every single day.  Are there serious risks associated with long-term beta blocker use?  Aside from lethargy and fatigue?  And is the drug even effective?  If my SCD risk is lowered by 5%, I'd rather not take it.  

Thank you.  
2 Responses
20748650 tn?1521032211
COMMUNITY LEADER
Do you even HAVE SCD risk? What makes you think you have SCD risk?
13 Comments
I get couplets and triplets (NSVT), as well as bigeminy, mostly during sex but also when I'm in a stressful situation, like when I'm talking to someone I don't like.  Strangely, I haven't gotten any of it during exercise.  
This doesn’t necessarily mean you have SCD risk.

You can actually go into VT for a Solid 20 seconds or more and still not have markedly increased SCD risk.
Actually recent studies have shown even shown the opposite.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0160181

"In patients without structural heart disease, presence of NSVT on 24-hour monitoring was independently associated with death, CV hospitalization, ischemic stroke, TIA, and new onset heart failure."

But doctors seem insistent on peddling this "benign" nonsense anyway.
Here we go...

Ok. You are correct. I don’t know what I even bothered going to school to study ventricular tachycardia for 6 years for?

Would you care to tell me which specific type of NSVT is most associated with an increased risk of death?

Should I be more worried about Outflow tract NSVT, Fascicular NSVT, Ischemic NSVT, ARVC-NSVT?

I was a little confused because the article didn’t say...

In fact it would appear that the article looked at all types of VT.. and didn’t separate VT from genetic causes Or early ischemic VT that can appear in seemingly structurally normal hearts...

It also didn’t seem to include any data about excluding patients with higher Ventricular ectopic burdens who were at risk for development of TCM...

You have seen to done more research than me or any of my nonsense peddling colleagues though, so I digress.. would you care to comment?

As a clear subject matter expert in cardiac electrophysiology Id imagine you have a lot to say.
Pardon me for being frustrated but you have to understand these are patients with baseline anxiety and heart symptoms. They are inherently scared about their situation and exceptionally vulnerable to being mislead by misrepresentation of the data.

This makes the task of treating them appropriately astronomically more difficult as their confidence in the health system and years of reassurance can be eroded.

Is NSVT a predictor of death from cardiac causes?

Yes, OF COURSE it is. Because NSVT in general includes both benign *and* malignant *types* of NSVT under its umbrella. Likewise different patients have different unique characteristics which put them at more or less risk.

Therefore, Is *every* specific TYPE of NSVT a predictor. No, They are NOT. Some types of NSVT are benign and other types are dangerous. Which is why we TRIAGE and MONITOR patients with NSVT for characteristics of these etiologies.

We don’t just say “oop there’s some NSVT!” Then subsequently tell them they are going to die. There’s more to it than that.

Ask yourself this:

First, was any specific analysis done to determine risk for patients with NSVT and NO known cormorbities such as HTN, DM, CAD etc. *NO*

All of the specific population analysis was conducted on patients with preexisting illnesses which we SCREEN FOR when assessing the risk of any patient with ventricular ectopy.

Second, Did *every* patient in that study die from CV events after 10 years?

No, in fact just 8.1% of them died specifically of cardiac causes after 10 years. The average age of these patients was not 20 y/o in this study.. it was 67 on enrollment. Meaning the patients were 77 years old at the time of analysis. This is saying that 65.5% of patients with NSVT can expect live to see the age of 77; a reasonable life expectancy.

Third, did this study include younger populations of patients in their 20’s and 30’s? NO.

The YOUNGEST NSVT patient in the study was 51 years old. Subgroup analysis suggested that patients between the ages of 51-65 were at a higher risk of death if NSVT is present (198% of normal) compared with the 65-84 year olds (153%). This suggests that among people with NSVT higher death rates are most pronounced at the age of 51-75 and it less obvious as old age starts causing people to die regardless of NSVT presence.

Limitations of this study include a lack of inclusion of younger subgroups (such as the individuals we see posting here), insufficient data volume for subgroups (this study was only able to recruit 220 NSVT patients of ANY age) and lack of exclusionary criteria for known malignant VT etiologies.

When we discuss NSVT with patients, ESPECIALLY young patients, we do our best to reassure them that the most common variants of NSVT without comorbidities in the young are in fact NOT lethal and that life expectancy is good, because it is.

We assess them to rule out the biggest risk factors, monitor them to ensure they don’t develop signs of a more lethal rhythm issue and strive to recognize more advanced disease processes early and treat them.




I’d also like to quote my own post from this very same topic in response to this, which is fully validated by the results of the “recent data” you posted without any clear critical analysis:

“ All couplets, patterns and NSVT tells us is that you MAY be at higher risk. However all that ultimately depends on what the diagnostic workup shows.

It is one component of risk stratification but on its own means nothing. It needs to be taken in context with other data, family history, nature of symptoms, echo results(EF), pvc burden, coronary history etc.”
Shame most doctors don't do any of this "diagnostic workup." I am just dismissed. I have never been given any proper testing beyond a holter, told to ignore them and go away, not told what type of NSVT I have or anything like that.

So that's nonsense.
Well I dont know what magical world of doctoring you live in then but no doctor has taken the time to give two hoots about my NSVT so all I can do is look at research papers, and the conclusion to see seems pretty obvious, since I can't get a diagnostic workup as doctors refuse to care.
Seeing NSVT on a two lead holter does not tell them where mine are coming from, no investigation into the type, just given beta blockers and discharged, which don't work by the way.
This is at 3 seperate hospitals
The study also clearly states "Our previous study demonstrated that patients with multiform PVC had an increased risk of mortality, hospitalization, new-onset HF, and new-onset AF independent of other clinical risks" - I have multifocal PVCs yet the doctors still dismiss me so how else am I meant to feel?
Q: Should I be more worried about Outflow tract NSVT, Fascicular NSVT, Ischemic NSVT, ARVC-NSVT?

A: "NSVT was defined as 3 or more consecutive beats arising below the atrioventricular node, with an RR interval less than 600 ms and lasting less than 30 seconds." - seems it was a typical RVOT monomorphic NSVT.

Q: In fact it would appear that the article looked at all types of VT.. and didn’t separate VT from genetic causes Or early ischemic VT that can appear in seemingly structurally normal hearts...

A: exclusion criteria in our study were as follows: participants with prevalent sustained ventricular tachycardia, permanent pacemaker, heart failure (HF), previous myocardial infarction, catheter ablation, pulmonary hypertension or hypertrophic cardiomyopathy, and valvular heart disease.

Q: It also didn’t seem to include any data about excluding patients with higher Ventricular ectopic burdens who were at risk for development of TCM...

A: Clearly stated all patients had a relatively low burden: n the present study, the mean PVC burden was 176 ± 423 beats per day and none of these patients had PVC burden more than 5% of the total beats. Therefore, the PVC burden was lower than that in previous studies. Furthermore, the incidence of multiform morphology PVCs between NSVT and non-NSVT groups was not different (37.1% vs 42.1%, P = 0.132)

Q:First, was any specific analysis done to determine risk for patients with NSVT and NO known cormorbities such as HTN, DM, CAD etc. *NO*

A: *YES* - "Clinical features for these patients, including past medical history, comorbidities, and medications, were obtained from hospital discharge diagnoses, outpatient visits, emergency visits, and the Collaboration Center of Health Information Application (CCHIA), Ministry of Health and Welfare in Taiwan" -  Target comorbidities, such as diabetes mellitus, hypertension, chronic kidney disease, liver disease, and thyroid disease were determined by using the ICD-9 codes derived from patient medical charts and CCHIA at the time of examination. -  NSVT was associated with increased mortality, CV hospitalization, new-onset stroke/TIA, and development of systolic HF *** independent of sex, age, and other comorbidities.  ***

Q: Second, Did *every* patient in that study die from CV events after 10 years?

A: An 8.1% chance of death is not a good thing and I am not sure why you're selling it as such?

Q: Third, did this study include younger populations of patients in their 20’s and 30’s? NO.

A: There's nothing to suggest it didn't? The hospital used in the study treats patients of all ages.

Q: Limitations of this study include a lack of inclusion of younger subgroups

A: Not seeing this anywhere in the study?

Q: This study was only able to recruit 220 NSVT patients of ANY age

A: There were 3767 out of 5903 in the study with NSVT, not 220?
And yes I may be getting some of it wrong because I am not a scientist or a researcher but like I say we are left to fend for ourselves, so what else are we to do. If we draw the wrong conclusions, who's fault is that?
20748650 tn?1521032211
COMMUNITY LEADER
To clarify:

All couplets, patterns and NSVT tells us is that you MAY be at higher risk. However all that ultimately depends on what the diagnostic workup shows.

It is one component of risk stratification but on its own means nothing. It needs to be taken in context with other data, family history, nature of symptoms, echo results(EF), pvc burden, coronary history etc.
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