© 2004 European Society of Cardiology
Beta-blocker induced bradycardia—should we pace?
Department of Internal Medicine III, University of Cologne Cologne, Germany
| The first 10% of the full text of this article appears below. |
| 1. Beta-blocker therapy in guidelines |
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Beta-blockade improves survival, reduces hospitalisations for heart failure, and improves left ventricular function when given over a long period of time to patients with symptomatic systolic heart failure in the functional classes NYHA II–IV. Current international guidelines recommend the initiation of beta-blocker therapy in all stable symptomatic patients with systolic heart failure, using one of the three beta-blockers (bisoprolol, carvedilol or metoprolol), which have been shown to reduce morbidity and mortality in outcome trials. In asymptomatic patients in functional class NYHA I, the European Society of Cardiology recommends beta-blocker therapy following myocardial infarction, while the American Heart Association extends the recommendation to all asymptomatic patients with systolic dysfunction. Beta-blocker medication should be started at a very low dose and should be titrated up to the high maintenance dosages shown
| 2. Do we have to titrate up beta-blocker therapy in heart failure patients? |
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| 3. Pacing in heart failure: good or bad? |
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| 4. Conclusions |
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