Epicardial vasospasm and concomitant ventricular tachycardia treated with Beta-1-specific Beta-blockade: a case series in support of nebivolol

Patients who experience ventricular tachycardia and cardiac arrest induced by epicardial vasospasm are at high risk for recurrent cardiac events. Conventional treatment includes calcium channel-blockade, long-acting nitrates, and the withdrawal of beta-blockade. These guidelines have not been proven effective in randomized controlled trials, and the evidence against beta-blockade is primarily anecdotal. Ongoing medical management in the setting of treatment failure is unclear, but abnormal sympathetic activity has been implicated in both spasm and ventricular arrhythmias.

We describe three patients with spasm-related ventricular arrhythmias and unacceptably poor response to conventional treatment. Clinical stability and asymptomatic status were achieved following the addition of nebivolol, a third-generation, lipophilic beta-1-specific beta-blocker.

Selective beta-blockade may represent a therapeutic option in patients with high-risk epicardial spasm and ventricular arrhythmias. Furthermore, the apparent success of nebivolol in this setting suggests that hyperactive sympathetic input may represent a causal or aggravating factor in spasm-associated ventricular arrhythmias.