Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure?
Aleem U. Khand, MD, MRCP ,
Andrew C. Rankin, MD, MRCP*,
William Martin, PhD*,
Jacqueline Taylor, MBChB, MRCP*,
Islay Gemmell, MSc, PhD and
John G. F. Cleland, MD, MRCP, FACC,*
* Department of Cardiology, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom
Academic Unit of Cardiology, University of Hull, Kingston-upon-Hull, United Kingdom
Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom
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Figure 1 Study design. *Randomization at this stage determined pairing of therapies in phase 2. Carv. = carvedilol; DB = double-blind; Dig. = digoxin; OL = open-label.
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Figure 2 (A to C) Mean hourly heart rate (HR) as influenced by treatment regimen(s) during ambulatory 24-h electrocardiogram. Points with an asterisk represent significant differences in HR between groups. At baseline, by chance, the ventricular rate tended to be higher in the carvedilol-treated group throughout 24 h, but this difference was only statistically significant for a few hours. Analyses are intergroup changes from baseline values.
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Figure 3 Ventricular rate during submaximal exercise. (A) Pre-carvedilol (open triangles) and placebo (solid triangles) groups at baseline. (B) Phase 1 (four months): combination therapy (solid squares) versus digoxin alone (open squares). (C) Phase 2 (six months): digoxin alone (open circles) versus carvedilol alone (solid circles).
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