Ventricular rate control and exercise performance in chronic atrial fibrillation: effects of diltiazem and verapamil
T Lundstrom
and
L Ryden
Department of Cardiology, Central Hospital, Skovde, Sweden.
The effects of two calcium channel blockers, diltiazem (270 mg/day) and verapamil (240 mg/day), were studied in 18 patients with chronic atrial fibrillation. During 24 h Holter electrocardiographic monitoring, mean ventricular rate (beats/min) decreased from 88 +/- 14 with placebo to 76 +/- 13 (p less than 0.001) with diltiazem and 80 +/- 11 (p less than 0.01) with verapamil. Maximal symptom-limited exercise tolerance (W) increased from 127 +/- 39 during the placebo period to 136 +/- 42 (p less than 0.01) with diltiazem and 137 +/- 39 (p less than 0.01) with verapamil. Ventricular rate and rate-pressure product were lower at rest and during exercise with diltiazem and verapamil than with placebo (p less than 0.001), with the drugs being similarly effective. Ventricular rate at maximal exercise (beats/min) was 179 +/- 13 with placebo compared with 159 +/- 21 with diltiazem and 158 +/- 23 with verapamil. Maximal oxygen uptake (ml/kg per min) was 22.3 +/- 4.5 with placebo, 23.7 +/- 4.9 (p less than 0.05) with diltiazem and 22.9 +/- 4.5 with verapamil (p = NS). Respiratory gas exchange anaerobic threshold was reached at a work load (W) of 76 +/- 21 with placebo, 84 +/- 27 (p less than 0.05) with diltiazem and 85 +/- 23 (p less than 0.01) with verapamil. In conclusion, patients with chronic atrial fibrillation have modestly improved exercise tolerance with calcium channel blockade therapy. The dromotropic responses and the effects on physical performance are of similar magnitude for diltiazem and verapamil.
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85(1004):
303 - 312.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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BMJ,
November 24, 2007;
335(7629):
1057 - 1058.
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[PDF]
|
|
|
|
|
|
|
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|
|
|
|
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[PDF]
|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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August 1, 2006;
92(8):
1096 - 1101.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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J. Am. Coll. Cardiol.,
April 7, 2004;
43(7):
1201 - 1208.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Snow, K. B. Weiss, M. LeFevre, R. McNamara, E. Bass, L. A. Green, K. Michl, D. K. Owens, J. Susman, D. I. Allen, et al.
Management of Newly Detected Atrial Fibrillation: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians
Ann Intern Med,
December 16, 2003;
139(12):
1009 - 1017.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. L. McNamara, L. J. Tamariz, J. B. Segal, and E. B. Bass
Management of Atrial Fibrillation: Review of the Evidence for the Role of Pharmacologic Therapy, Electrical Cardioversion, and Echocardiography
Ann Intern Med,
December 16, 2003;
139(12):
1018 - 1033.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Sticherling, H. Tada, W. Hsu, A. C. Bares, H. Oral, F. Pelosi, B. P. Knight, S. A. Strickberger, and F. Morady
Effects of Diltiazem and Esmolol on Cycle Length and Spontaneous Conversion of Atrial Fibrillation
Journal of Cardiovascular Pharmacology and Therapeutics,
June 1, 2002;
7(2):
81 - 88.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T Levy, S Walker, M Mason, P Spurrell, S Rex, S Brant, and V Paul
Importance of rate control or rate regulation for improving exercise capacity and quality of life in patients with permanent atrial fibrillation and normal left ventricular function: a randomised controlled study
Heart,
February 1, 2001;
85(2):
171 - 178.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
G. E. Kochiadakis, E. M. Kanoupakis, M. D. Kalebubas, N. E. Igoumenidis, K. E. Vardakis, H. E. Mavrakis, and P. E. Vardas
Sotalol vs metoprolol for ventricular rate control in patients with chronic atrial fibrillation who have undergone digitalization: a single-blinded crossover study
Europace,
January 1, 2001;
3(1):
73 - 79.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. Farshi, D. Kistner, J. S. M. Sarma, J. A. Longmate, and B. N. Singh
Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens
J. Am. Coll. Cardiol.,
February 1, 1999;
33(2):
304 - 310.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Adult Advanced Cardiac Life Support
JAMA,
October 28, 1992;
268(16):
2199 - 2241.
[Abstract]
[PDF]
|
|
|
|
