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Comparison of Four Single-Drug Regimens on Ventricular Rate and Arrhythmia-Related Symptoms in Patients With Permanent Atrial Fibrillation

Ulimoen, Sara R.; Enger, Steve; Carlson, Jonas LU ; Platonov, Pyotr LU ; Pripp, Are H.; Abdelnoor, Michael; Arnesen, Harald; Gjesdal, Knut and Tveit, Amljot (2013) In American Journal of Cardiology 111(2). p.225-230
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 13 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... (More)
Rate control of atrial fibrillation (AF) is a main treatment modality. However, data are scarce on the relative efficacy of calcium channel blockers and 13 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 13 blockers. (C) 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:225-230) (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
American Journal of Cardiology
volume
111
issue
2
pages
225 - 230
publisher
Excerpta Medica
external identifiers
  • wos:000313607100013
  • scopus:84872005941
ISSN
1879-1913
DOI
10.1016/j.amjcard.2012.09.020
language
English
LU publication?
yes
id
c0bd690b-675b-49e0-b9a9-cb05e5bb9fba (old id 3470526)
date added to LUP
2013-03-01 07:45:31
date last changed
2019-05-19 03:15:53
@article{c0bd690b-675b-49e0-b9a9-cb05e5bb9fba,
  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 13 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 &lt;0.001 for all). The 24-hour heart rate was significantly lower with diltiazem than with any other drug tested (p &lt;0.001 for all). Compared to baseline, diltiazem significantly reduced both the frequency (p &lt;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 13 blockers. (C) 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:225-230)},
  author       = {Ulimoen, Sara R. and Enger, Steve and Carlson, Jonas and Platonov, Pyotr and Pripp, Are H. and Abdelnoor, Michael and Arnesen, Harald and Gjesdal, Knut and Tveit, Amljot},
  issn         = {1879-1913},
  language     = {eng},
  number       = {2},
  pages        = {225--230},
  publisher    = {Excerpta Medica},
  series       = {American Journal of Cardiology},
  title        = {Comparison of Four Single-Drug Regimens on Ventricular Rate and Arrhythmia-Related Symptoms in Patients With Permanent Atrial Fibrillation},
  url          = {http://dx.doi.org/10.1016/j.amjcard.2012.09.020},
  volume       = {111},
  year         = {2013},
}