Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation
Abstract
Rate control of atrial fibrillation (AF) is a main treatment modality. However, data are scarce on the relative efficacy of calcium channel blockers and β blockers or between drugs within each class. The purpose of the present study was to compare the effect of 4 rate-reducing, once-daily drug regimens on the ventricular heart rate and arrhythmia-related symptoms in patients with permanent AF. We included 60 patients (mean age 71 ± 9 years, 18 women) with permanent AF in an investigator-blind cross-over study. Diltiazem 360 mg/day, verapamil 240 mg/day, metoprolol 100 mg/day, and carvedilol 25 mg/day were administered for 3 weeks in a randomized sequence. The 24-hour heart rate was measured using Holter monitoring, and arrhythmia-related symptoms were assessed using the Symptom Checklist questionnaire before randomization and on the last day of each treatment period. The 24-hour mean heart rate was 96 ± 12 beats/min at baseline (no treatment), 75 ± 10 beats/min with diltiazem, 81 ± 11 beats/min with verapamil, 82 ± 11 beats/min with metoprolol, and 84 ± 11 beats/min with carvedilol. All drugs reduced the heart rate compared to baseline (p <0.001 for all). The 24-hour heart rate was significantly lower with diltiazem than with any other drug tested (p <0.001 for all). Compared to baseline, diltiazem significantly reduced both the frequency (p <0.001) and the severity (p = 0.005) of symptoms. In contrast, verapamil reduced symptom frequency only (p = 0.012). In conclusion, diltiazem 360 mg/day was the most effective drug regimen for reducing the heart rate in patients with permanent AF. Arrhythmia-related symptoms were reduced by treatment with the calcium channel blockers diltiazem and verapamil, but not by the β blockers.
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Verapamil or diltiazem provides reasonable rate control in AF patients.
“Verapamil or diltiazem provides reasonable rate control in AF patients.541”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [541]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
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Self-citationRate control drugs differ in the prevention of progression of atrial fibrillation
Koldenhof, T., Wijtvliet, P. E. P. J., Pluymaekers, N. A. H. A., Rienstra, M., Folkeringa, R. J., Bronzwaer, P., Elvan, A., Elders, J., Tukkie, R., Luermans, J. G. L. M., et al. (2022) · EP Europace · doi:10.1093/europace/euab191 · Cited by 25 · see citing works
- Authors
- Ulimoen, S. R., Enger, S., Carlson, J., Platonov, P. G., Pripp, A. H., Abdelnoor, M., Arnesen, H., Gjesdal, K., & Tveit, A.
- Affiliations
- Vestre Viken Hospital Trust (NO)
- Lund University (SE)
- Oslo University Hospital (NO)
- Corresponding author
- Ulimoen, Sara R.
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-01
- Volume
- 111
- Issue
- 2
- Pages
- 225-230
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2035457614
- Cited by
- 113
- References
- 16
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 17 · 2023: 6 · 2022: 5 · 2021: 10 · 2020: 9 · 2019: 7 · 2018: 5 · 2017: 5 · 2016: 8 · 2015: 9 · 2014: 10 · 2013: 9
- FWCI
- 5.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- permanent atrial fibrillation, rate control, ventricular rate, calcium channel blockers, beta-blockers, diltiazem, verapamil, metoprolol, carvedilol, 24-hour heart rate
- MeSH terms
- Adrenergic beta-Antagonists, Aged, Anti-Arrhythmia Agents, Atrial Fibrillation, Calcium Channel Blockers, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Heart Rate, Heart Ventricles, Humans, Male, Prospective Studies, Electrocardiography, Ambulatory, Single-Blind Method, Treatment Outcome, Cross-Over Studies
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