{"id":"2cf348a06e3b","type":"article","url":"https://hartvaat.nl/2026/05/21/eplerenon-halveert-recidief-ventriculaire-tachycardie-versus-spironolacton-bij-h/","title":"Eplerenon halveert recidief ventriculaire tachycardie versus spironolacton bij hartfalen","title_en":"","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","aperitif-trial","carvedilol","emperor-trials","eplerenon","mra-aldosteronantagonisten","pathfinder-trial","rechterventrikelfalen","sacubitril-valsartan","step-hfpef","supraventriculaire-tachycardie","ventriculaire-tachycardie","ventrikelfibrilleren"],"journal":"Open heart","doi":"10.1136/openhrt-2025-003858","source_url":"https://doi.org/10.1136/openhrt-2025-003858","authors":["Imre Szakál","Ferenc Komlósi","Patrik Tóth","Bence Arnóth","Gyula Bohus","Péter Vámosi","Nándor Szegedi","Zoltán Salló","István Osztheimer","Péter Perge","Gábor Orbán","Attila Kardos","Béla Merkely","László Gellér","Klaudia Vivien Nagy"],"significance":6,"published":"2026-06-08","source_date":"2026-05-21","image":"https://hartvaat.nl/global/img/0e25c2fc9e34.webp","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/ritmestoornissen/ventriculaire-tachycardie/"],"congress":"","summary_en":"Retrospective analysis of heart failure patients with LVEF <50% hospitalised for sustained monomorphic ventricular tachycardia (VT) and receiving a mineralocorticoid receptor antagonist (MRA) at discharge. Of 292 eligible patients, 202 were matched via propensity scoring on 13 variables (median LVEF 30%, 87% male, median follow-up 32 months). All-cause mortality did not differ between eplerenone and spironolactone (HR 0.98). However, eplerenone was associated with significantly fewer VT recurrences (HR 0.42; 95% CI 0.26-0.66; Fine-Gray aHR 0.36; p<0.001). The finding favours eplerenone in HF patients with a history of monomorphic VT, albeit based on observational data.","created":"2026-07-03T10:33:01Z","updated":"2026-07-03T18:39:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Retrospectieve analyse van hartfalenpatiënten met LVEF <50% die opgenomen werden voor sustained monomorfe ventriculaire tachycardie (VT) en bij ontslag een mineralocorticoïdreceptor-antagonist (MRA) kregen. Van 292 in aanmerking komende patiënten werden 202 gematcht via propensity scoring op 13 variabelen (mediane LVEF 30%, 87% mannen, mediane follow-up 32 maanden). De totale mortaliteit verschilde niet tussen eplerenon en spironolacton (HR 0,98). Eplerenon was echter geassocieerd met aanzienlijk minder VT-recidieven (HR 0,42; 95%-BI 0,26-0,66; Fine-Gray aHR 0,36; p<0,001). De bevinding pleit voor eplerenon-voorkeur bij hartfalenpatiënten met monomorfe VT-historie, zij het op basis van observationele data.","abstract_original":"BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) are core therapy in chronic heart failure (HF) and reduce all-cause mortality and sudden cardiac death. However, direct comparisons of spironolactone and eplerenone in the context of ventricular arrhythmia recurrence are lacking. This study aims to compare the effects of these two MRAs on all-cause mortality and recurrence of sustained monomorphic ventricular tachycardia (VT) in patients with HF. METHODS: We analysed data of HF patients with left ventricular ejection fraction (LVEF) below 50%, hospitalised for sustained monomorphic VT and receiving MRA therapy at discharge. We performed propensity score matching for 13 variables, including medical history, medication and arrhythmia presentation. The endpoints were all-cause mortality and VT recurrence. RESULTS: Among the 292 patients who met the selection criteria, 202 were included in the final analysis after propensity score matching, representing 69% of the eligible cohort. Median age was 67 (61-74) years and 87% were male. The median LVEF was 30% (25%-35%). The median follow-up duration was 32 (18-36) months, with a minimum follow-up of 1 year. During follow-up, 70 patients died, while VT recurrence was observed in 86 patients. There was no significant difference in all-cause mortality between the two MRAs (HR 0.98 (0.62 to 1.57), p=0.94). However, eplerenone was associated with a significantly lower risk of VT recurrence compared with spironolactone (HR 0.42 (0.26 to 0.66), p<0.001, Fine-Gray adjusted HR 0.36 (0.22 to 0.59), p<0.001). CONCLUSIONS: In HF patients with sustained monomorphic VT, eplerenone was associated with fewer VT recurrences than spironolactone, without differences in all-cause mortality."}