Maintenance of sinus rhythm with metoprolol CR initiated before cardioversion and repeated cardioversion of atrial fibrillation: a randomized double-blind placebo-controlled study

Nergardh, A. K; Rosenqvist, M.; Nordlander, R.; Frick, M.

doi:10.1093/eurheartj/ehl544

Cited by 65Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

Maintenance of sinus rhythm with metoprolol CR initiated before cardioversion and repeated cardioversion of atrial fibrillation: a randomized double-blind placebo-controlled study

Nergardh, A. K, Rosenqvist, M., Nordlander, R., Frick, M.·2007·European Heart Journal

DOI 10.1093/eurheartj/ehl544

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Abstract

AIMS: To assess the effect of metoprolol in combination with repeated cardioversion on maintenance of sinus rhythm (SR). METHODS AND RESULTS: Consecutive outpatients with persistent atrial fibrillation (AF) were randomized to treatment with metoprolol CR or placebo in a double-blind fashion. Study treatment was started at least one week before direct current (DC) cardioversion. Patients were followed once a week during the first 6 weeks after cardioversion. In case of relapse during this period, a second cardioversion was performed. Total treatment time was 6 months. A total of 168 patients were randomized to metoprolol (n = 83) or placebo (n = 85). The dose of study treatment at cardioversion was 169 +/- 47 mg in the metoprolol group and 180 +/- 40 mg in the placebo group (P = 0.12). In an intention-to-treat analysis, 46 patients (55%) in the metoprolol group and 34 patients (40%) in the placebo group (P = 0.04) had SR 1 week after cardioversion, and 38 patients (46%) in the metoprolol group compared with 22 patients (26%) in the placebo group had SR after 6 months (P < 0.01). CONCLUSION: A treatment strategy of metoprolol CR started before cardioversion in combination with prompt second cardioversion in case of early relapse (1-6 weeks) significantly increases the proportion of patients in SR during six months of follow-up.

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Beta-blockers have been reported to reduce symptomatic atrial fibrillation recurrences.
“Beta-blockers have also been reported to reduce symptomatic AF recurrences, 580,636,688”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [636]

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Authors: Nergardh, A. K., Rosenqvist, M., Nordlander, R., & Frick, M.
Affiliations: Karolinska Institutet (SE)
ORCID: Rosenqvist, M.
Venue: European Heart Journal
Publisher: Oxford University Press (OUP)
Published: 2007-06-01
Volume: 28
Issue: 11
Pages: 1351-1357
ISSN: 0195-668X (ISSN-L)
1522-9645
DOI: 10.1093/eurheartj/ehl544
OpenAlex: W2136795635
Cited by: 65
References: 29
Citations by year: 2026: 1 · 2025: 3 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 5 · 2020: 2 · 2019: 6 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 3 · 2014: 5 · 2013: 5 · 2012: 5
FWCI: 0.70
Type: journal article
Language: en
Open access: closed
Locations: European Heart Journal (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Funders: Hjärt-Lungfonden
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords: metoprolol, atrial fibrillation, cardioversion, sinus rhythm maintenance, atrial fibrillation recurrence, persistent atrial fibrillation, antiarrhythmic therapy
MeSH terms: Aged, Anti-Arrhythmia Agents, Atrial Fibrillation, Combined Modality Therapy, Double-Blind Method, Electric Countershock, Female, Humans, Male, Metoprolol, Recurrence, Treatment Outcome, Retreatment

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Maintenance of sinus rhythm with metoprolol CR initiated before cardioversion and repeated cardioversion of atrial fibrillation: a randomized double-blind placebo-controlled study

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