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The Lead Episode 69: Effect of Carvedilol vs Metoprolol on Atrial and Ventricular Arrhythmias Among Implantable Cardioverter-Defibrillator Recipients

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Sirena Bridges, MSN, FNP-BC, CCDS, VA Tennessee Valley Healthcare, and Jodie L. Hurwitz,  MD, FHRS, North Texas Heart Center to discuss the effects of metoprolol and carvedilol on the risk of atrial tachyarrhythmia (ATA) and ventricular arrhythmia (VA) in over 4,000 heart failure (HF) patients with a primary prevention implantable cardioverter-defibrillator (ICD) by pooling data from five landmark ICD trials. Carvedilol treatment was associated with a 35% reduction in the risk of ATA and a corresponding decrease in the risk of inappropriate ICD shocks when compared to metoprolol. While there was a trend towards a lower risk of fast VA with carvedilol, this finding did not reach statistical significance. Carvedilol's unique properties, including its ability to block both β and α receptors, improve hemodynamics, and exhibit antiarrhythmic effects, may contribute to its superior outcomes. Overall, these results suggest that carvedilol may be preferred as the first-line beta-blocker choice in HF patients with a primary prevention ICD, but further prospective studies are needed to validate these findings and assess the impact of contemporary HF therapies on arrhythmic outcomes. 

Learning Objectives
  • Assess the impact of beta-blocker type (metoprolol vs carvedilol) on the risk of atrial tachyarrhythmia (ATA) in heart failure (HF) patients with a primary prevention implantable cardioverter-defibrillator (ICD).
  • Evaluate the association between beta-blocker type (metoprolol vs carvedilol) and the risk of ventricular arrhythmia (VA) in HF patients with a primary prevention ICD, considering the implications for clinical management and choice of medication. 
Article Authors and Podcast Contributors
Article Authors

Diamond, Ilan Goldenberg, Arwa Younis, Ido Goldenberg, Ramya Sampath, Valentina Kutyifa, Anita Y. Chen, Scott McNitt, Bronislava Polonsky, Jonathan S. Steinberg, Wojciech Zareba, and Mehmet K. Aktas

Podcast Contributors

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital
Sirena Bridges, MSN, FNP-BC, CCDS, VA Tennessee Valley Healthcare
Jodie L. Hurwitz, MD, FHRS, North Texas Heart Center

Disclosure Policy

ACE Disclosure Policy

The Heart Rhythm Society is committed to the provision of Accredited Continuing Education (formerly known as Continuing Medical Education (CME)) that is balanced, objective, and evidence based. HRS adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME) which require that those individuals in a position to control the content of an educational activity (including, but not limited to, planners, faculty, authors, committee members, content reviewers, editors, and staff) disclose all financial relationships with an ACCME-defined ineligible company* within the 24 months prior to the disclosure.


Any individual who refuses to disclose financial relationships is disqualified from participating in HRS ACE-certified activities. Owners and employees of ACCME-defined ineligible companies may have no role in the planning or implementation of ACE activities without a special written exemption from the HRS Chief Learning Officer that will be granted only in specific circumstances that meet ACCME requirements.

ACCME Definition:

*An ineligible company is one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Examples of such organizations include:

  • Advertising, marketing, or communication firms whose clients are ineligible companies
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  • Manufacturers of health-related wearable products
  • Pharmaceutical companies or distributors
  • Pharmacy benefit managers
  • Reagent manufacturers or sellers


All relevant financial relationships have been mitigated.

Host Disclosure(s):

D. Varghese: Nothing to disclose.

Contributor Disclosure(s):
S. Bridges: Nothing to disclose.
J. Hurwitz: Nothing to disclose.

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):
S. Sailor: No relevant financial relationships with ineligible companies to disclose.
S. Colbert: No relevant financial relationships with ineligible companies to disclose.
ACE Statements
Accreditation Statement

The Heart Rhythm Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Physicians AMA Designation Statement
The Heart Rhythm Society designates this internet-enduring activity for a maximum of .25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM Maintenance of Certification (MOC) Statement 
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Successful completion of this ACE activity, which includes participation in the evaluation component, enables the participant to earn up to .25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of ACE credits claimed for the activity. It is the ACE activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Royal College of Physicians and Surgeons of Canada MOC Recognition Statement
Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “ACE in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

Other Credit Available
A Credit Certificate (for physicians) or Certificate of Participation (for non-physicians) will be provided to individuals seeking credit from the following organizations which accept AMA PRA Category 1 Credit(s)™. Note that participants are advised to contact their certifying body for specific information regarding credit submissions:
·         American Academy of Family Physicians (AAFP) (for elective credit)
·         American Academy of Nurse Practitioners Certification Board (AANPCB)
·         American Academy of Physician Assistants (AAPA)
·         American Nurses Credentialing Center (ANCC)
·         American Osteopathic Association (AOA) (for Category 2 credit)
·         Committee on Accreditation of Continuing Medical Education (Canada)
·         European Board for Accreditation in Cardiology (EBAC)
·         European CME Credits (ECMEC)
·         German Chambers of Physicians
·         National Society of Genetic Counselors (for Category 2 credit)
·         Oman Medical Specialty Board
·         Qatar Council for Healthcare Practitioners
·         Royal College of Physicians and Surgeons of Canada (RCPSC)

Availability: On-Demand
Cost: FREE
Credit Offered:
0.25 ACE Credit
0.25 COP Credit
0.25 ABIM-MOC Point
0.25 ABP-MOC Point
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