Verapamil did not significantly reduce the recurrence of atrial fibrillation at 1 month compared to digoxin after electrical cardioversion (47% vs 53%, P=NS).
RCT (n=97)
randomized
Absolute Event Rate: 47% vs 53%
p-value: p=NS
INTRODUCTION: Many relapses of atrial fibrillation (AF) occur, especially during the first week(s) after electrical cardioversion (ECV). The aim of the present study was to compare in a randomized design the efficacy of verapamil (intracellular calcium lowering) versus digoxin (calcium increasing) for maintenance of sinus rhythm after ECV. METHODS AND RESULTS: Ninety-seven patients with persistent AF were randomized to verapamil (n = 49) or digoxin (n = 48) for 1 month before and 1 month after ECV. The first month after ECV, patients recorded heart rhythm using daily transtelephonic monitoring. No additional antiarrhythmic drugs were given. Of the 97 patients, 43 patients (20 verapamil) underwent ECV per protocol. Median previous AF duration was 18 and 26 days for verapamil and digoxin, respectively. There were no differences in atrial dimensions and underlying heart disease between the two groups. The success rate of ECV was 75% versus 83% (P = NS). After 1 month, 47% versus 53% (P = NS) had recurrence of AF. Median time to recurrence was 5 days (range 0 to 26) versus 8 days (range 2 to 28) (P = NS), respectively. CONCLUSION: Stand-alone intracellular calcium lowering by verapamil around ECV does not enhance cardioversion outcome.
Noord et al. (Sun,) conducted a rct in persistent atrial fibrillation (n=97). verapamil vs. digoxin was evaluated on recurrence of atrial fibrillation after 1 month (p=NS). Verapamil did not significantly reduce the recurrence of atrial fibrillation at 1 month compared to digoxin after electrical cardioversion (47% vs 53%, P=NS).