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July 1, 1988European Heart Journal

Relationships between heart rate, exercise tolerance and cardiac output in atrial fibrillation: the effects of treatment with digoxin, verapamil and diltiazem

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Why the study?

Does treatment with digoxin, verapamil, and diltiazem (alone or in combination) improve exercise tolerance and cardiac output in patients with chronic atrial fibrillation?

Population

6 patients with chronic atrial fibrillation (AF)

Comparison

Single doses of digoxin, verapamil, and… vs Placebo

Design

Other

Follow-up

3 hours after dosing

Authors

RLR V LewisNinewells HospitalNINicola A. IrvineGlasgow Caledonian UniversityDMD. G. McDevittQueen's University Belfast

Discussion

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Implication

May not warrant further rate slowing with calcium antagonists in digitalized AF; leaves open optimal ventricular rate targets for exercise capacity.

Key Points

  • This research investigates how heart rate treatments affect exercise tolerance and cardiac output in patients with atrial fibrillation.
  • Six patients with chronic atrial fibrillation took single doses of digoxin, verapamil, and diltiazem.
  • Measurements were taken for resting and post-exercise heart rate, exercise tolerance, and cardiac output three hours after dosing.
  • The study explored the effects of these treatments both alone and in combinations.
  • Post-exercise heart rates varied significantly, with 167 bpm after placebo and 122 bpm after digoxin plus diltiazem (P<0.05).
  • Despite reduced ventricular rates, exercise tolerance did not show significant improvement across treatments.
  • While stroke volume slightly increased with treatment, it did not translate into higher cardiac output due to rate-related reductions.

Structured PICO

Does treatment with digoxin, verapamil, and diltiazem (alone or in combination) improve exercise tolerance and cardiac output in patients with chronic atrial fibrillation?

P
Population
6 patients with chronic atrial fibrillation (AF)
I
Intervention
Single doses of digoxin, verapamil, and diltiazem, alone and in combination
C
Comparator
Placebo
O
Outcome
Resting and post-exercise heart rate, exercise tolerance, and resting and post-exercise cardiac output measured 3 hours after dosingsurrogate

Further reduction of rapid ventricular rates in digitalized patients with AF using calcium antagonists does not appear to improve exercise tolerance or cardiac output.

Cite This Study

Lewis et al. (1988) studied this question.

synapsesocial.com/papers/6a123460c031bb6829a6180ehttps://doi.org/10.1093/eurheartj/9.7.777

Topics

Atrial fibrillationPersistent AF managementAnticoagulation in AFAF ablation outcomes
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A comparison of digoxin, diltiazem and their combination in the treatment of atrial fibrillation1988 · 56 citations
  2. 2Efficacy and safety of medium- and high-dose diltiazem alone and in combination with digoxin for control of heart rate at rest and during exercise in patients with chronic atrial fibrillation.1986 · 199 citations
  3. 3Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens1999 · 366 citations
  4. 4Left Ventricular Performance During Acute Rate Control in Atrial Fibrillation: The Importance of Heart Rate and Agent Used2003 · 10 citations
  5. 5Factors affecting the clinical response to treatment with digoxin and two calcium antagonists in patients with atrial fibrillation.1988 · 10 citations