Should bisoprolol (Beta blocker) be administered after ventricular tachycardia (VT) ablation?

From the Guidelines

Bisoprolol should be considered after VT ablation in patients with structural heart disease, particularly left ventricular dysfunction, heart failure, or prior myocardial infarction, as it may be beneficial for its cardioprotective effects and to reduce the risk of arrhythmia recurrence, as suggested by the 2015 ESC guidelines 1. The decision to prescribe bisoprolol following VT ablation should be individualized based on the patient's underlying cardiac condition, ablation outcome, and other clinical factors.

• The patient's underlying cardiac condition, such as left ventricular dysfunction or heart failure, should be taken into account when deciding whether to prescribe bisoprolol.
• The ablation outcome, including the success of the procedure in eliminating the arrhythmogenic substrate, should also be considered.
• Other clinical factors, such as the patient's history of myocardial infarction or the presence of other cardiac conditions, should also be taken into account. If the patient has structural heart disease, bisoprolol (starting at 1.25 mg daily and titrating up to 10 mg daily as tolerated) may be beneficial for its cardioprotective effects and to reduce the risk of arrhythmia recurrence, as shown in the MADIT-II study and the Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) study 1.
• Beta-blockers like bisoprolol work by blocking sympathetic stimulation, which can trigger arrhythmias, and they help control heart rate and reduce myocardial oxygen demand.
• The use of beta-blockers, such as bisoprolol, in combination with other medications, such as amiodarone, may also be considered to reduce the risk of arrhythmia recurrence and improve patient outcomes. However, if the VT ablation was completely successful in eliminating the arrhythmogenic substrate and the patient has no other indications for beta-blocker therapy, bisoprolol may not be necessary.
• The decision should be made in consultation with the electrophysiologist who performed the procedure, taking into account the specific characteristics of the patient's arrhythmia, ablation outcome, and overall cardiac status.
• The patient's quality of life and potential side effects of bisoprolol should also be considered when making the decision.

From the Research

Ventricular Tachycardia Ablation and Beta-Blocker Use

• The provided studies do not directly address the question of whether to give bisoprolol after VT ablation 2, 3, 4, 5, 6.
• However, study 5 suggests that beta-blocker use is associated with improved survival in patients with ventricular fibrillation or symptomatic ventricular tachycardia who are not treated with specific antiarrhythmic therapy.
• The use of beta-blockers, such as bisoprolol, may be considered in patients with VT, especially those with structural heart disease, as part of a comprehensive treatment plan 5.
• Studies 2, 3, 4, 6 discuss the role of catheter ablation in the management of VT, but do not provide specific guidance on the use of bisoprolol after ablation.

Considerations for Beta-Blocker Use

• The decision to use beta-blockers, including bisoprolol, after VT ablation should be based on individual patient characteristics, such as underlying heart disease, symptoms, and response to treatment 5.
• The potential benefits and risks of beta-blocker use should be carefully weighed, taking into account the patient's overall clinical profile and treatment goals 5.