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Rate-Control Drugs Affect Variability and Irregularity Measures of RR Intervals in Patients with Permanent Atrial Fibrillation

Corino, Valentina D. A.; Ulimoen, Sara R.; Enger, Steve; Mainardi, Luca T.; Tveit, Arnljot and Platonov, Pyotr LU (2015) In Journal of Cardiovascular Electrophysiology 26(2). p.137-141
Abstract
Heart Rate Variability and Irregularity During AF IntroductionIrregularity measures have been suggested as risk indicators in patients with atrial fibrillation (AF); however, it is not known to what extent they are affected by commonly used rate-control drugs. We aimed at evaluating the effect of metoprolol, carvedilol, diltiazem, and verapamil on the variability and irregularity of the ventricular response in patients with permanent AF. Methods and ResultsSixty patients with permanent AF were part of an investigator-blind cross-over study, comparing 4 rate-control drugs (diltiazem, verapamil, metoprolol, and carvedilol). We analyzed five 20-minute segments per patient: baseline and the 4 drug regimens. On every segment, heart rate (HR)... (More)
Heart Rate Variability and Irregularity During AF IntroductionIrregularity measures have been suggested as risk indicators in patients with atrial fibrillation (AF); however, it is not known to what extent they are affected by commonly used rate-control drugs. We aimed at evaluating the effect of metoprolol, carvedilol, diltiazem, and verapamil on the variability and irregularity of the ventricular response in patients with permanent AF. Methods and ResultsSixty patients with permanent AF were part of an investigator-blind cross-over study, comparing 4 rate-control drugs (diltiazem, verapamil, metoprolol, and carvedilol). We analyzed five 20-minute segments per patient: baseline and the 4 drug regimens. On every segment, heart rate (HR) variability and irregularity of RR series were computed. The variability was assessed as standard deviation, pNN20, pNN50, pNN80, and rMSSD. The irregularity was assessed by regularity index, approximate (ApEn), and sample entropy. A significantly lower HR was obtained with all drugs, the HR was lowest using the calcium channel blockers. All drugs increased the variability of ventricular response in respect to baseline (as an example, rMSSD: baseline 171 47 milliseconds, carvedilol 229 +/- 58 milliseconds; P < 0.05 vs. baseline, metoprolol 226 +/- 66 milliseconds; P < 0.05 vs. baseline, verapamil 228 +/- 84; P < 0.05 vs. baseline, diltiazem 256 +/- 87 milliseconds; P < 0.05 vs. baseline and all other drugs). Only -blockers significantly increased the irregularity of the RR series (as an example, ApEn: baseline 1.86 +/- 0.13, carvedilol 1.92 +/- 0.09; P < 0.05 vs. baseline, metoprolol 1.93 +/- 0.08; P < 0.05 vs. baseline, verapamil 1.86 +/- 0.22 ns, diltiazem 1.88 +/- 0.16 ns). ConclusionModification of AV node conduction by rate-control drugs increase RR variability, while only -blockers affect irregularity. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
atrial fibrillation, -blockers, calcium-channel blockers, entropy, irregularity, rate-control drugs, time domain parameters, variability
in
Journal of Cardiovascular Electrophysiology
volume
26
issue
2
pages
137 - 141
publisher
Wiley-Blackwell
external identifiers
  • wos:000349626600004
  • scopus:84922540012
ISSN
1540-8167
DOI
10.1111/jce.12580
language
English
LU publication?
yes
id
05f8ceea-a608-41d1-a438-1a451845c408 (old id 5160242)
date added to LUP
2015-04-01 07:40:20
date last changed
2017-01-01 03:21:33
@article{05f8ceea-a608-41d1-a438-1a451845c408,
  abstract     = {Heart Rate Variability and Irregularity During AF IntroductionIrregularity measures have been suggested as risk indicators in patients with atrial fibrillation (AF); however, it is not known to what extent they are affected by commonly used rate-control drugs. We aimed at evaluating the effect of metoprolol, carvedilol, diltiazem, and verapamil on the variability and irregularity of the ventricular response in patients with permanent AF. Methods and ResultsSixty patients with permanent AF were part of an investigator-blind cross-over study, comparing 4 rate-control drugs (diltiazem, verapamil, metoprolol, and carvedilol). We analyzed five 20-minute segments per patient: baseline and the 4 drug regimens. On every segment, heart rate (HR) variability and irregularity of RR series were computed. The variability was assessed as standard deviation, pNN20, pNN50, pNN80, and rMSSD. The irregularity was assessed by regularity index, approximate (ApEn), and sample entropy. A significantly lower HR was obtained with all drugs, the HR was lowest using the calcium channel blockers. All drugs increased the variability of ventricular response in respect to baseline (as an example, rMSSD: baseline 171 47 milliseconds, carvedilol 229 +/- 58 milliseconds; P &lt; 0.05 vs. baseline, metoprolol 226 +/- 66 milliseconds; P &lt; 0.05 vs. baseline, verapamil 228 +/- 84; P &lt; 0.05 vs. baseline, diltiazem 256 +/- 87 milliseconds; P &lt; 0.05 vs. baseline and all other drugs). Only -blockers significantly increased the irregularity of the RR series (as an example, ApEn: baseline 1.86 +/- 0.13, carvedilol 1.92 +/- 0.09; P &lt; 0.05 vs. baseline, metoprolol 1.93 +/- 0.08; P &lt; 0.05 vs. baseline, verapamil 1.86 +/- 0.22 ns, diltiazem 1.88 +/- 0.16 ns). ConclusionModification of AV node conduction by rate-control drugs increase RR variability, while only -blockers affect irregularity.},
  author       = {Corino, Valentina D. A. and Ulimoen, Sara R. and Enger, Steve and Mainardi, Luca T. and Tveit, Arnljot and Platonov, Pyotr},
  issn         = {1540-8167},
  keyword      = {atrial fibrillation,-blockers,calcium-channel blockers,entropy,irregularity,rate-control drugs,time domain parameters,variability},
  language     = {eng},
  number       = {2},
  pages        = {137--141},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Cardiovascular Electrophysiology},
  title        = {Rate-Control Drugs Affect Variability and Irregularity Measures of RR Intervals in Patients with Permanent Atrial Fibrillation},
  url          = {http://dx.doi.org/10.1111/jce.12580},
  volume       = {26},
  year         = {2015},
}