Key result
Digoxin plus atenolol reduces 24-hour ventricular rate by ~14 bpm vs digoxin alone in chronic AF.
Why the study?
Systematic comparisons of standardized drug regimens on 24-hour ventricular rate control in chronic atrial fibrillation had not been reported.
Do different pharmacologic regimens (digoxin, diltiazem, atenolol, or their combinations) improve 24-hour ventricular rate control in patients with chronic atrial fibrillation?
RCT (n=12)
Open-label
random order
Do different pharmacologic regimens (digoxin, diltiazem, atenolol, or their combinations) improve 24-hour ventricular rate control in patients with chronic atrial fibrillation?
Answers are grounded in this paper and cite their sources.
In patients with chronic atrial fibrillation, combination therapy with digoxin and atenolol provides more effective 24-hour ventricular rate control than monotherapy with digoxin, diltiazem, or atenolol.
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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Farshi et al. (1999) conducted an RCT in chronic atrial fibrillation (CAF) (n=12). digoxin + atenolol vs. digoxin alone was evaluated on 24-h mean ventricular rate (VR) (p=< 0.0001). In patients with chronic atrial fibrillation, digoxin plus atenolol produced the most effective 24-hour ventricular rate control compared to digoxin alone.
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