Rate control drugs differ in the prevention of progression of atrial fibrillation
Open accessAbstract
AIMS: We hypothesize that in patients with paroxysmal atrial fibrillation (AF), verapamil is associated with lower AF progression compared to beta blockers or no rate control. METHODS AND RESULTS: In this pre-specified post hoc analysis of the RACE 4 randomized trial, the effect of rate control medication on AF progression in paroxysmal AF was analysed. Patients using Vaughan-Williams Class I or III antiarrhythmic drugs were excluded. The primary outcome was a composite of first electrical cardioversion (ECV), chemical cardioversion (CCV), or atrial ablation. Event rates are displayed using Kaplan-Meier curves and multivariable Cox regression analyses are used to adjust for baseline differences. Out of 666 patients with paroxysmal AF, 47 used verapamil, 383 used beta blockers, and 236 did not use rate control drugs. The verapamil group was significantly younger than the beta blocker group and contained more men than the no rate control group. Over a mean follow-up of 37 months, the primary outcome occurred in 17% in the verapamil group, 33% in the beta blocker group, and 33% in the no rate control group (P = 0.038). After adjusting for baseline characteristics, patients using verapamil have a significantly lower chance of receiving ECV, CCV, or atrial ablation compared to patients using beta blockers [hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.19-0.83] and no rate control (HR 0.64, 95% CI 0.44-0.93). CONCLUSION: In patients with newly diagnosed paroxysmal AF, verapamil was associated with less AF progression, as compared to beta blockers and no rate control.
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Verapamil slows conduction through the AV node without significantly impairing exercise capacity, making it a reasonable choice in selected patients.
“Verapamil slows conduction through the AV node without significantly impairing exercise capacity, making it a reasonable choice in selected patients.”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [86]
The Discussion (page unavailable) says verapamil lowers heart rate during atrial fibrillation, supporting the rate-control aspect of the claim. It does not identify slowed AV-node conduction as the mechanism or assess exercise capacity. The Discussion’s Limitations also caution that these findings cannot yet be extrapolated to clinical practice, so the recommendation for selected patients is not established by this study. (LLM, conf=0.77)
Experimental — accuracy not yet measuredVerapamil, a non-dihydropyridine calcium channel blocker, is a viable option and can sometimes be more effective than beta-blockers in controlling heart rate, especially in athletes who are sensitive to the fatigue or reduced exercise tolerance commonly associated with beta-blockers.
“Verapamil, a non-dihydropyridine calcium channel blocker, is a viable option and can sometimes be more effective than beta-blockers in controlling heart rate, especially in athletes who are sensitive to the fatigue or reduced exercise tolerance commonly associated with beta-blockers [86].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [86]
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- Authors
- 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., van Kuijk, S. M. J., Tijssen, J. G. P., van Gelder, I. C., Crijns, H. J. G. M., & Tieleman, R. G.
- Affiliations
- University of Groningen (NL)
- Maastricht University Medical Centre (NL)
- Medisch Centrum Leeuwarden (NL)
- Zaans Medisch Centrum (NL)
- Isala (NL)
- Canisius-Wilhelmina Ziekenhuis (NL)
- Spaarne Ziekenhuis (NL)
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Amsterdam UMC Location University of Amsterdam (NL)
- Department of Cardiology, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Corresponding author
- Koldenhof, Tim
- ORCID
- Venue
- EP Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-08-20
- Volume
- 24
- Issue
- 3
- Pages
- 384-389
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- PMC
- PMC8892061
- OpenAlex
- W3194403625
- Cited by
- 25
- References
- 27
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 9 · 2023: 11 · 2022: 1 · 2021: 1
- FWCI
- 3.69
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- EP Europace (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, cc-by-nc)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- Netherlands healthcare insurance companies (DSW
- ACHMEA
- Boehringer Ingelheim
- Bayer
- Pfizer
- Bristol-Myers Squibb
- Daiichi Sankyo
- 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 electrophysiology and arrhythmias
- Keywords
- paroxysmal atrial fibrillation, atrial fibrillation progression, rate control, verapamil, beta-blockers, electrical cardioversion, chemical cardioversion, atrial ablation, newly diagnosed atrial fibrillation
- MeSH terms
- Anti-Arrhythmia Agents, Atrial Fibrillation, Electric Countershock, Humans, Male, Treatment Outcome, Catheter Ablation
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