Management of Ventricular Arrhythmias with Beta-Blockers

Introduction to Beta-Blocker Therapy

The European Society of Cardiology recommends beta-blockers as the first-line antihypertensive medication for decreasing ventricular arrhythmias, particularly in patients with coronary artery disease, heart failure, or structural heart disease 1, 2, 3
In patients with hypertension and ventricular arrhythmias, achieving and maintaining adequate blood pressure control with beta-blockers should be a priority, especially in those with severe left ventricular systolic dysfunction (EF < 35%) 1, 2

Beta-blockers are specifically recommended for management of hypertension in the setting of coronary artery disease and heart failure 2
Beta-blockers are particularly useful for polymorphic ventricular tachycardia due to myocardial ischemia 4, 5

ACE inhibitors and ARBs should be used for hypertension management in patients at high risk for sudden cardiac death 2
In patients with heart failure and reduced ejection fraction (HFrEF), a combination of beta-blocker, mineralocorticoid receptor antagonist (MRA), and either an ACE inhibitor, ARB, or angiotensin receptor-neprilysin inhibitor is recommended to reduce sudden cardiac death and all-cause mortality 4, 5
Avoiding hypokalemia and QT-prolonging drugs should be a priority in the context of hypertension and left ventricular hypertrophy 2

For patients with sustained ventricular arrhythmias or frequent non-sustained ventricular arrhythmias with LV systolic dysfunction, treatment with beta-blocker, MRA, and sacubitril/valsartan reduces the risk of sudden death 1, 2
Antiarrhythmic drugs should not be used routinely in patients with heart failure and asymptomatic ventricular arrhythmias due to safety concerns (worsening HF, proarrhythmia, and death) 2