From the Guidelines
Bisoprolol can be a useful treatment option for supraventricular bigeminy, particularly in patients who are not candidates for or prefer not to undergo catheter ablation. As a beta-blocker, bisoprolol works by slowing the heart rate and reducing the excitability of the cardiac conduction system, which can decrease the frequency of premature atrial contractions that cause bigeminy 1. The typical starting dose is 2.5 mg once daily, which may be gradually increased to 5-10 mg daily based on response and tolerance. Some key points to consider when using bisoprolol for supraventricular bigeminy include:
- Patients should take bisoprolol at the same time each day, and the medication should not be stopped abruptly as this can worsen arrhythmias.
- Side effects may include fatigue, dizziness, and bradycardia.
- Bisoprolol is contraindicated in patients with severe bradycardia, heart block, or decompensated heart failure.
- The effectiveness varies between individuals, and some patients may require additional or alternative treatments.
- Regular monitoring of heart rate and blood pressure is necessary during treatment. According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia, oral beta blockers, such as bisoprolol, are recommended for ongoing management in patients with symptomatic SVT who do not have ventricular pre-excitation during sinus rhythm 1. Bisoprolol works by blocking beta-1 adrenergic receptors in the heart, reducing the influence of the sympathetic nervous system and thereby decreasing the likelihood of ectopic beats that lead to bigeminy patterns. It is essential to weigh the benefits and risks of bisoprolol treatment for each patient and to consider alternative treatment options, such as catheter ablation, which may be more effective for some patients.
From the Research
Supraventricular Bigeminy and Bisoprolol
- Supraventricular bigeminy is a type of arrhythmia characterized by alternating premature atrial contractions and normal heartbeats.
- Beta-blockers, such as bisoprolol, have been used to treat various types of arrhythmias, including supraventricular arrhythmias 2.
- A study published in 2022 found that bisoprolol is effective in treating supraventricular arrhythmias, including atrial fibrillation, and has a high quality of evidence to support its use 2.
- Another study published in 1986 found that bisoprolol reduced the frequency of premature atrial contractions (PAC) in 50% of patients, suggesting its potential effectiveness in treating supraventricular bigeminy 3.
Mechanism of Action
- Bisoprolol works by selectively blocking beta-1 adrenergic receptors, which reduces the heart rate and contractility, thereby decreasing the frequency of arrhythmias 2, 4.
- The antiarrhythmic effects of bisoprolol are thought to be due to its ability to reduce the automaticity of the heart and increase the refractory period, making it more difficult for arrhythmias to occur 3.
Clinical Evidence
- While there is limited direct evidence on the use of bisoprolol specifically for supraventricular bigeminy, the available studies suggest that it may be effective in reducing the frequency of premature atrial contractions and improving symptoms 2, 3.
- A study published in 2021 suggested that certain beta-blockers, such as bisoprolol, may be reevaluated for use in patients with left ventricular hypertrophy to reduce the risk of ventricular arrhythmias 5.