Intravenous verapamil significantly reduced median heart rate from 145 to 95 bpm (p<0.001) in patients with atrial fibrillation, with a 12.6% incidence of hypotension.
Observational (n=223)
Does intravenous verapamil safely reduce heart rate in patients with atrial fibrillation?
Intravenous verapamil effectively reduced heart rate in AF patients, and adverse events were associated with baseline systolic blood pressure and hemoglobin rather than LVEF or BNP, challenging the strict contraindication in heart failure.
p-value: p=<0.001
Objective According to the current guidelines, the use of non-dihydropyridine calcium-channel blockers for the rate control of atrial fibrillation (AF) is contraindicated in patients with heart failure (HF), especially in those with a reduced ejection fraction (EF). However, there is little data supporting this recommendation. This study aimed to investigate the use of intravenous verapamil in patients with AF. Methods We retrospectively studied 223 consecutive patients with AF treated with intravenous verapamil. We evaluated the clinical data of these patients, including any adverse events that occurred within 7 days. Results The median age of the patients was 75.9 (67.8-80.7) years. Before administration, 71 patients (31.8%) had HF, 112 patients (62.6%) had a high B-type natriuretic peptide (BNP) level, and 28 patients (13.6%) had a left ventricular (LV) EF less than 50%. The mean administered dose of verapamil was 5.4±1.6 mg. The median heart rate (HR) was significantly reduced after verapamil administration HR:145 (130-160) bpm to 95 (82-105) bpm, p<0.001. Twenty-eight patients (12.6%) suffered from hypotension. Two patients had bradyarrhythmias. Within 7 days, cardiovascular death occurred in three patients (1.3%). A multivariate analysis revealed that pre sBP and hemoglobin, but not LVEF or BNP, were independently associated with adverse events. Conclusion The intravenous administration of verapamil appears to be effective and safe for controlling the heart rate in most patients with AF, except in critically ill patients. However, further research is required to assess the safety of verapamil in patients for whom its use is not currently recommended by the clinical guidelines.
Baba et al. (Fri,) conducted a observational in Atrial fibrillation (n=223). Intravenous verapamil was evaluated on Heart rate reduction (p=<0.001). Intravenous verapamil significantly reduced median heart rate from 145 to 95 bpm (p<0.001) in patients with atrial fibrillation, with a 12.6% incidence of hypotension.