Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation
Abstract
AIMS: Rate control of atrial fibrillation (AF) has become a main treatment modality, but we need more knowledge regarding the different drugs used for this purpose. In this study, we aimed to compare the effect of four common rate-reducing drugs on exercise capacity and levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with permanent AF. METHODS AND RESULTS: We included 60 patients (mean age 71 ± 9 years, 18 women) with permanent AF and normal left ventricular function in a randomized, cross-over, investigator-blind study. Diltiazem 360 mg, verapamil 240 mg, metoprolol 100 mg, and carvedilol 25 mg were administered o.d. for 3 weeks. At baseline and on the last day of each treatment period, the patients underwent a maximal cardiopulmonary exercise test and blood samples were obtained at rest and at peak exercise. The exercise capacity (peak VO2) was significantly lower during treatment with metoprolol and carvedilol compared with baseline (no treatment) or treatment with diltiazem and verapamil (P < 0.001 for all). Compared with baseline, treatment with diltiazem and verapamil significantly reduced the NT-proBNP levels both at rest and at peak exercise, whereas treatment with metoprolol and carvedilol increased the levels (P < 0.05 for all). CONCLUSION: Rate-reducing treatment with diltiazem or verapamil preserved exercise capacity and reduced levels of NT-proBNP compared with baseline, whereas treatment with metoprolol or carvedilol reduced the exercise capacity and increased levels of NT-proBNP.
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In one small trial of low-risk patients with preserved LVEF, beta-blockers reduced exercise capacity and increased B-type natriuretic peptide.
“Verapamil or diltiazem can improve arrhythmia-related symptoms, 526 in comparison with beta-blockers, which reduced exercise capacity and increased B-type natriuretic peptide in one small trial of low-risk patients with preserved LVEF.542”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [542]
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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
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Rate- and Rhythm-Control Therapies in Patients With Atrial Fibrillation: A Systematic Review
Al-Khatib, S. M., Allen LaPointe, N. M., Chatterjee, R., Crowley, M. J., Dupre, M. E., Kong, D. F., Lopes, R. D., Povsic, T. J., Raju, S. S., Shah, B., et al. (2014) · Annals of Internal Medicine · doi:10.7326/m13-1467 · Cited by 178 · see citing works
- Authors
- Ulimoen, S. R., Enger, S., Pripp, A. H., Abdelnoor, M., Arnesen, H., Gjesdal, K., & Tveit, A.
- Affiliations
- Vestre Viken Hospital Trust (NO)
- Oslo University Hospital (NO)
- Corresponding author
- Ulimoen, Sara R.
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-10-17
- Volume
- 35
- Issue
- 8
- Pages
- 517-524
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2137768025
- Cited by
- 87
- References
- 57
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 15 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 9 · 2019: 3 · 2018: 7 · 2017: 5 · 2016: 8 · 2015: 5 · 2014: 5 · 2013: 1
- FWCI
- 4.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- permanent atrial fibrillation, calcium channel blockers, beta-blockers, rate control, exercise capacity, N-terminal pro-brain natriuretic peptide, diltiazem, verapamil, metoprolol, carvedilol, cardiopulmonary exercise testing, peak oxygen uptake
- MeSH terms
- Carvedilol, Adrenergic beta-Antagonists, Aged, Atrial Fibrillation, Calcium Channel Blockers, Carbazoles, Delayed-Action Preparations, Diltiazem, Female, Humans, Male, Metoprolol, Oxygen Consumption, Peptide Fragments, Propanolamines, Prospective Studies, Verapamil, Exercise Tolerance, Cross-Over Studies, Natriuretic Peptide, Brain
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