Heart rate control by carvedilol in Japanese patients with chronic atrial fibrillation: The AF Carvedilol study

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• 作者：Hiroshi Inoue ; MD ; PhD ; FJCC^a ; ^{h-inoue@saiseikai-toyama.jp} ; Hirotsugu Atarashi ; MD ; PhD ; FJCC^b ; Ken Okumura ; MD ; PhD ; FJCC^c ; ¹ ; Takeshi Yamashita ; MD ; PhD ; FJCC^d ; Masayuki Fukuzawa ; MSPharm^e ; Kazuhito Shiosakai ; MSc^f ; Tetsuya Kimura ; MSPharm^g
• 关键词：Atrial fibrillation ; Carvedilol ; Heart rate control
• 刊名：Journal of Cardiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：69
• 期：1
• 页码：293-301
• 全文大小：1025 K
• 卷排序：69

文摘

β-Blockers are used to control heart rate (HR) in patients with atrial fibrillation (AF). However, the appropriate dosage and efficacy of carvedilol in Japanese AF patients are yet to be clarified.MethodsIn this multicenter, randomized, double-blind study, Japanese patients with persistent or permanent AF received carvedilol for 6 weeks in the following three dosage-regimen groups: 5-mg fixed-dose (n = 42), 10-mg dose-escalation (n = 42), or 20-mg dose-escalation (n = 43). To evaluate the efficacy of each dosage regimen and the dose–response relationship, changes in 24-h mean HR (mHR) on Holter electrocardiograms from baseline to weeks 2, 4, and 6 were determined as primary endpoints. The effects on circadian changes in HR, the proportion of patients achieving target HR, clinical symptoms, and adverse events were also examined.ResultsAfter 2 weeks, carvedilol 5 mg decreased 24-h mHR significantly [6.6 (95% CI: 5.2–8.0) beats/min, p < 0.0001]. After 6 weeks, carvedilol showed a trend of dose-dependent HR reduction (p = 0.0638): 7.6 (5.4–9.8) in the 5-mg fixed-dose group; 8.9 (6.7–11.1) in the 10-mg dose-escalation group; and 10.6 (8.4–12.8) beats/min in the 20-mg dose-escalation group. There were no serious adverse events related to carvedilol.ConclusionsIn Japanese patients with persistent or permanent AF, carvedilol at 5 mg once daily demonstrated a significant HR reduction, and step-wise dose escalation from 5 mg to 20 mg showed a trend of dose-dependent HR reduction.