CLINICAL STUDIES
Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens
Ramin Farshi, MDa,
Deborah Kistner, RNa,
Jonnalagedda S. M. Sarma, PhD, FACCa,
Jeffrey A. Longmate, PhD* and
Bramah N. Singh, MD, PhD, FACCa
a Division of Cardiology, West Los Angeles VA Medical Center, UCLA School of Medicine, Los Angeles, California, USA
* City of Hope Medical Center, Duarte, California, USA
Manuscript received January 6, 1998;
revised manuscript received August 3, 1998,
accepted October 2, 1998.
Reprint requests and correspondence: Dr. Bramah N. Singh, Division of Cardiology 111E, VA Medical Center of West Los Angeles, 113021 Wilshire Boulevard, Los Angeles, California 90073
OBJECTIVES
We compared the effects of five pharmacologic regimens on the circadian rhythm and exercise-induced changes of ventricular rate (VR) in patients with chronic atrial fibrillation (CAF).
BACKGROUND
Systematic comparison of standardized drug regimens on 24 h VR control in CAF have not been reported.
METHODS
In 12 patients (11 male, 69 ± 6 yr) with CAF, the effects on VR by 5 standardized daily regimens: 1) 0.25 mg digoxin, 2) 240 mg diltiazem-CD, 3) 50 mg atenolol, 4) 0.25 mg digoxin + 240 mg diltiazem-CD, and 5) 0.25 mg digoxin + 50 mg atenolol; were studied after 2 week treatment assigned in random order. The VR data were analyzed by ANOVA with repeated measures. The circadian phase differences were evaluated by cosinor analysis.
RESULTS
The 24-h mean (±SD) values of VR (bpm) were – digoxin: 78.9 ± 16.3, diltiazem: 80.0 ± 15.5, atenolol: 75.9 ± 11.7, digoxin + diltiazem: 67.3 ± 14.1 and digoxin + atenolol: 65.0 ± 9.4. Circadian patterns were significant in each treatment group (p < 0.001). The VR on digoxin + atenolol was significantly lower than that on digoxin (p < 0.0001), diltiazem (p < 0.0002) and atenolol (p < 0.001). The time of peak VR on Holter was significantly delayed with regimens 3 and 5 which included atenolol (p < 0.03). During exercise, digoxin and digoxin + atenolol treatments resulted in the highest and lowest mean VR respectively. The exercise Time-VR plots of all groups were nearly parallel (p = ns). The exercise duration was similar in all treatment groups (p = ns).
CONCLUSIONS
This study indicates that digoxin and diltiazem, as single agents at the doses tested, are least effective for controlling ventricular rate in atrial fibrillation during daily activity. Digoxin + atenolol produced the most effective rate control reflecting a synergistic effect on the AV node. The data provides a basis for testing the effects of chronic suppression of diurnal fluctuations of VR on left atrial and ventricular function in CAF.
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Abbreviations and Acronyms
| | ANOVA | = analysis of variance | | AV node | = atrio-ventricular node | | bpm | = beats per minute | | CAF | = chronic atrial fibrillation | | LVEF | = left ventricular ejection fraction | | VR | = ventricular rate |
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3(3):
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|
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|
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Chronic atrial fibrillation: a systematic review of medical heart rate control management
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85(1004):
303 - 312.
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119(18):
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|
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|
|
|
|
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53(15):
e1 - e90.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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J. Am. Coll. Cardiol.,
April 14, 2009;
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1343 - 1382.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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April 14, 2009;
119(14):
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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April 14, 2009;
119(14):
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[PDF]
|
|
|
|
|
|
|
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January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
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|
|
|
|
|
|
|
A. J. Camm, P. Kirchhof, G. Y.H. Lip, I. Savelieva, and S. Ernst
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January 1, 2009;
2(1):
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|
|
|
|
|
|
|
For questions on page
Emerg. Med. J.,
December 1, 2008;
25(12):
860 - 860.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Nikolaidou and K. S Channer
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BMJ,
November 24, 2007;
335(7629):
1057 - 1058.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Kirchhof, A. Auricchio, J. Bax, H. Crijns, J. Camm, H.-C. Diener, A. Goette, G. Hindricks, S. Hohnloser, L. Kappenberger, et al.
Outcome parameters for trials in atrial fibrillation: executive summary: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA)
Eur. Heart J.,
November 2, 2007;
28(22):
2803 - 2817.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Kirchhof, A. Auricchio, J. Bax, H. Crijns, J. Camm, H.-C. Diener, A. Goette, G. Hindricks, S. Hohnloser, L. Kappenberger, et al.
Outcome parameters for trials in atrial fibrillation: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork and the European Heart Rhythm Association
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November 1, 2007;
9(11):
1006 - 1023.
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[Full Text]
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|
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
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J. Am. Coll. Cardiol.,
October 23, 2007;
50(17):
e159 - e242.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
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October 23, 2007;
116(17):
e418 - e500.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K.-T. Lim, M. J.E. Davis, A. Powell, L. Arnolda, K. Moulden, M. Bulsara, and R. Weerasooriya
Ablate and pace strategy for atrial fibrillation: long-term outcome of AIRCRAFT trial
Europace,
July 1, 2007;
9(7):
498 - 505.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A J Camm, I Savelieva, G Y H Lip, and on behalf of the Guideline Development Group for t
Rate control in the medical management of atrial fibrillation
Heart,
January 1, 2007;
93(1):
35 - 38.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al.
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace,
September 1, 2006;
8(9):
651 - 745.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
J. Am. Coll. Cardiol.,
August 15, 2006;
48(4):
e149 - e246.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Circulation,
August 15, 2006;
114(7):
e257 - e354.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Y H Lip and A. Tello-Montoliu
Management of atrial fibrillation.
Heart,
August 1, 2006;
92(8):
1177 - 1182.
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. C. Hoppe, J. M. Casares, H. Eiskjaer, A. Hagemann, J. G.F. Cleland, N. Freemantle, and E. Erdmann
Effect of Cardiac Resynchronization on the Incidence of Atrial Fibrillation in Patients With Severe Heart Failure
Circulation,
July 4, 2006;
114(1):
18 - 25.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. S. Chan, S. Vijan, F. Morady, and H. Oral
Cost-Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation
J. Am. Coll. Cardiol.,
June 20, 2006;
47(12):
2513 - 2520.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. V. Naccarelli
Antiadrenergic Therapy in the Control of Atrial Fibrillation
Journal of Cardiovascular Pharmacology and Therapeutics,
October 1, 2005;
10(4_suppl):
S33 - S43.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. H. Falk
Rate Control Is Preferable to Rhythm Control in the Majority of Patients With Atrial Fibrillation
Circulation,
June 14, 2005;
111(23):
3141 - 3150.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. H. Veloso and A. A.V. de Paola
Beta-Blockers Versus Digoxin to Control Ventricular Rate During Atrial Fibrillation
J. Am. Coll. Cardiol.,
June 7, 2005;
45(11):
1905 - 1906.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Shelton
The AFFIRM study: Approaches to control rate in atrial fibrillation
J. Am. Coll. Cardiol.,
December 21, 2004;
44(12):
2418 - 2418.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. L. Page
Newly Diagnosed Atrial Fibrillation
N. Engl. J. Med.,
December 2, 2004;
351(23):
2408 - 2416.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Bauer, A. D. McDonald, K. Nasir, L. Peller, J. J. Rade, J. M. Miller, A. W. Heldman, and J. K. Donahue
Inhibitory G Protein Overexpression Provides Physiologically Relevant Heart Rate Control in Persistent Atrial Fibrillation
Circulation,
November 9, 2004;
110(19):
3115 - 3120.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Task Force Members, J. Lopez-Sendo, K. Swedberg, J. McMurray, J. Tamargo, A. P. Maggioni, H. Dargie, M. Tendera, F. Waagstein, J. Kjekshus, et al.
Expert consensus document on {beta}-adrenergic receptor blockers: The Task Force on Beta-Blockers of the European Society of Cardiology
Eur. Heart J.,
August 1, 2004;
25(15):
1341 - 1362.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Olshansky, L. E. Rosenfeld, A. L. Warner, A. J. Solomon, G. O'Neill, A. Sharma, E. Platia, G. K. Feld, T. Akiyama, M. A. Brodsky, et al.
The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study: Approaches to control rate in atrial fibrillation
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]
|
|
|
|
|
|
|
A. U. Khand, A. C. Rankin, W. Martin, J. Taylor, I. Gemmell, and J. G. F. Cleland
Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure?
J. Am. Coll. Cardiol.,
December 3, 2003;
42(11):
1944 - 1951.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.J. Boos, J. Carlsson, and R.S. More
Rate or rhythm control in persistent atrial fibrillation?
QJM,
December 1, 2003;
96(12):
881 - 892.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. N. Singh
Ventricular Rate Control in Atrial Fibrillation: What is the Optimal Rate? The Concept of Controlling the Heart Rate Burden
Journal of Cardiovascular Pharmacology and Therapeutics,
March 1, 2003;
8(1):
1 - 3.
[PDF]
|
|
|
|
|
|
|
Y Blaauw, I C Van Gelder, and H J G M Crijns
Treatment of atrial fibrillation
Heart,
October 1, 2002;
88(4):
432 - 437.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. S. Aronow
Management of the Older Person With Atrial Fibrillation
J. Gerontol. A Biol. Sci. Med. Sci.,
June 1, 2002;
57(6):
M352 - 363.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
A. Ahmed, R. M. Allman, and J. F. DeLong
Inappropriate Use of Digoxin in Older Hospitalized Heart Failure Patients
J. Gerontol. A Biol. Sci. Med. Sci.,
February 1, 2002;
57(2):
M138 - 143.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology
Eur. Heart J.,
October 2, 2001;
22(20):
1852 - 1923.
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al.
ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology
J. Am. Coll. Cardiol.,
October 1, 2001;
38(4):
1266 - 1266.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. H. Falk
Atrial Fibrillation
N. Engl. J. Med.,
April 5, 2001;
344(14):
1067 - 1078.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Wattanasuwan, I. A. Khan, N. J. Mehta, P. Arora, N. Singh, B. C. Vasavada, and T. J. Sacchi
Acute Ventricular Rate Control in Atrial Fibrillation : IV Combination of Diltiazem and Digoxin vs IV Diltiazem Alone
Chest,
February 1, 2001;
119(2):
502 - 506.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
H.J.G.M Crijns, G Tjeerdsma, P.J de Kam, F Boomsma, I.C van Gelder, M.P van den Berg, and D.J van Veldhuisen
Prognostic value of the presence and development of atrial fibrillation in patients with advanced chronic heart failure
Eur. Heart J.,
August 1, 2000;
21(15):
1238 - 1245.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. L. Page
Beta-blockers for atrial fibrillation: must we consider asymptomatic arrhythmias?
J. Am. Coll. Cardiol.,
July 1, 2000;
36(1):
147 - 150.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. C. HAMMILL and R. D. HUBMAYR
The Rapidly Changing Management of Cardiac Arrhythmias
Am. J. Respir. Crit. Care Med.,
April 1, 2000;
161(4):
1070 - 1073.
[Full Text]
|
|
|
|
|
|
|
J. M. Mangrum and J. P. DiMarco
The Evaluation and Management of Bradycardia
N. Engl. J. Med.,
March 9, 2000;
342(10):
703 - 709.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. A. Grace and A.J. Camm
Voltage-gated calcium-channels and antiarrhythmic drug action
Cardiovasc Res,
January 1, 2000;
45(1):
43 - 51.
[Full Text]
[PDF]
|
|
|
|
