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

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• 作者：Sara R. Ulimoen ; MD^a ; ^{sara.ulimoen@gmail.com} ; Steve Enger ; RN^a ; Jonas Carlson ; MSc ; PhD^b ; Pyotr G. Platonov ; MD ; PhD^b ; Are H. Pripp ; PhD^c ; Michael Abdelnoor ; PhD^c ; Harald Arnesen ; MD ; PhD^d ; ^f ; Knut Gjesdal ; MD ; PhD^e ; ^f ; Arnljot Tveit ; MD ; PhD^a
• 刊名：The American Journal of Cardiology
• 出版年：2013
• 出版时间：15 January, 2013
• 年：2013
• 卷：111
• 期：2
• 页码：225-230
• 全文大小：401 K

文摘

Rate control of atrial fibrillation (AF) is a main treatment modality. However, data are scarce on the relative efficacy of calcium channel blockers and ¦Â 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 ¡À 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 ¡À 12 beats/min at baseline (no treatment), 75 ¡À 10 beats/min with diltiazem, 81 ¡À 11 beats/min with verapamil, 82 ¡À 11 beats/min with metoprolol, and 84 ¡À 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 ¦Â blockers.