Efficacy of Beta-blockers vs. Calcium Channel Blockers for Outflow Tract Ventricular Ectopy

Abstract

Objectives: To assess and compare the efficacy of beta-blockers and calcium channel blockers in reducing the burden of outflow tract ventricular ectopy (OTVE) in individuals with documented ventricular arrhythmias. Methodology: This quasi-experimental study was conducted at the Rawalpindi Institute of Cardiology over a three-month period, from January 2025 to March 2025. A total of 290 patients fulfilling the selection criteria were enrolled. Participants prescribed beta-blockers were assigned to Group A, while those receiving calcium channel blockers were designated as Group B. The primary outcome was defined as the reduction in OTVE burden, measured by the number of ectopic beats per hour on continuous ambulatory Holter monitoring. Secondary outcomes included symptomatic improvement—assessed using the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA)—as well as safety profiling. Results: Baseline Holter burden was similar between the beta-blocker group (26.28 ± 8.47) and the calcium channel blocker group (26.80 ± 9.72), with no significant difference (p = 0.620). After 12 weeks, a significant reduction in Holter burden was observed in both groups: 2.68 ± 2.25 in the beta-blocker group and 1.78 ± 2.02 in the calcium channel blocker group (p < 0.001). Baseline ASTA scores were also comparable (9.82 ± 1.46 vs. 10.85 ± 1.49; p = 0.626), and both groups demonstrated notable improvement at 12 weeks (3.06 ± 0.24 vs. 3.03 ± 0.18; p = 0.275). Conclusion: Both beta-blockers and calcium channel blockers effectively reduce arrhythmic burden and symptom severity in patients with OTVE. However, calcium channel blockers may offer superior long-term control of Holter burden, while beta-blockers appear more beneficial in patients exhibiting higher mean heart rates, prolonged PVC QRS durations, and greater coupling interval variability.