Calcium antagonist monotherapy significantly prolonged exercise duration and improved physical role function and symptom scores compared to digitalis in patients with permanent atrial fibrillation.
RCT (n=29)
Randomized
Yes
Does monotherapy with a beta-blocker or calcium antagonist improve quality of life and rate control compared to digitalis in patients with permanent atrial fibrillation?
Calcium antagonists are preferable to digitalis for short-term improvement of quality of life and exercise tolerance in patients with permanent atrial fibrillation.
Absolute Event Rate: 481% vs 430%
p-value: p=<0.05
BACKGROUND: The present study aimed to determine whether quality of life (QOL) in permanent atrial fibrillation (AF) patients would be improved by monotherapy with beta-blocker (BB) or calcium antagonist (CAA) as compared with digitalis. METHODS AND RESULTS: Twenty-nine patients with permanent AF under digitalis were randomized into BB (bisoprolol, atenolol or metoprolol) or CAA (verapamil) monotherapy treatment group. Twenty-five were men and the mean age was 67+/-8 years. After the assigned monotherapy, 12 patients received the other monotherapy in a cross-over fashion. Under each treatment, efficacy of rate control was determined by Holter electrocardiogram (ECG), treadmill testing and QOL questionnaire (Short Form-36 (SF-36) and Quality of Life of Atrial Fibrillation (AFQLQ)), and compared with the baseline digitalis treatment. CAA significantly increased mean and minimum heart rate (HR) in Holter ECG as compared with digitalis, whereas BB increased only minimum HR. Exercise duration in treadmill testing was significantly prolonged by CAA treatment, although it only tended to be prolonged by BB treatment. CAA but not BB improved role function-physical score of SF-36, and frequency and severity of symptoms of AFQLQ. CONCLUSION: These results indicate that CAA is preferable to digitalis when monotherapy is selected for short-term improvement of QOL and exercise tolerance in patients with permanent AF.
Tsuneda et al. (Sun,) conducted a rct in Permanent Atrial Fibrillation (n=29). Calcium antagonist (verapamil) or Beta-blocker vs. Digitalis was evaluated on Exercise duration in treadmill testing (seconds) for calcium antagonist vs digitalis (p=<0.05). Calcium antagonist monotherapy significantly prolonged exercise duration and improved physical role function and symptom scores compared to digitalis in patients with permanent atrial fibrillation.