From the Guidelines
Atenolol can be used to treat ventricular bigeminy, but its safety and effectiveness depend on the individual patient's overall cardiac health, and it is generally recommended to use beta blockers without intrinsic sympathomimetic activity, such as metoprolol, carvedilol, or bisoprolol, which have been proven to reduce mortality and reinfarction in patients with myocardial infarction 1.
Key Considerations
- Atenolol is a beta-blocker that works by slowing the heart rate and reducing the force of heart contractions, which can help suppress ventricular ectopic beats that cause bigeminy.
- The typical starting dose is 25-50 mg once daily, which may be increased to 100 mg daily if needed.
- Patients should take it consistently at the same time each day.
- However, atenolol is not appropriate for all patients with ventricular bigeminy, particularly those with:
- Severe heart failure
- Cardiogenic shock
- Certain types of heart block
- Severe bradycardia
- Side effects may include fatigue, dizziness, and cold extremities.
- Atenolol should never be stopped abruptly as this can worsen cardiac symptoms.
Treatment Decisions
- Treatment decisions should be based on whether the bigeminy is causing symptoms or occurs in the context of structural heart disease.
- Asymptomatic ventricular bigeminy in a structurally normal heart may not require specific treatment at all.
- The choice of beta blocker for an individual patient is based primarily on pharmacokinetic and side effect criteria, as well as on physician familiarity 1.
Recent Guidelines
- The 2017 AHA/ACC clinical performance and quality measures for adults with ST-elevation and non-ST-elevation myocardial infarction recommend the use of beta blockers without intrinsic sympathomimetic activity, such as carvedilol, sustained-release metoprolol succinate, or bisoprolol, for patients with myocardial infarction complicated by systolic cardiomyopathy or heart failure 1.
- The 2013 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction recommend initiating beta blockers orally, in the absence of contraindications, within the first 24 hours 1.
From the Research
Safety of Atenolol for Ventricular Bigeminy
- The safety and efficacy of atenolol for ventricular bigeminy can be evaluated based on available studies 2, 3, 4, 5, 6.
- A study published in 2002 found that atenolol significantly decreased symptom frequency and premature ventricular complex (PVC) count in patients with symptomatic ventricular arrhythmia without structural heart disease 5.
- Another study published in 1994 discussed the role of beta-blockers, including atenolol, in the treatment of arrhythmias, but did not specifically address ventricular bigeminy 2.
- There is limited direct evidence on the safety of atenolol for ventricular bigeminy, but available studies suggest that atenolol can be effective in reducing symptoms and PVC count in patients with ventricular arrhythmias 5.
- A case report published in 2022 highlighted the importance of close vigilance of arterial pressure tracings in patients with bigeminy PVCs, but did not specifically discuss the use of atenolol 3.
- A study published in 2020 discussed the use of beta-blockers, including atenolol, in the management of atrial fibrillation and non-ischaemic cardiomyopathy in the peripartum period, but did not address ventricular bigeminy specifically 4.
- Atenolol has been shown to be effective in reducing left ventricular hypertrophy in hypertensive patients, with significant reductions in posterior and septal wall thicknesses and left ventricular mass observed after 4 weeks of treatment 6.