Document Detail


Modulation of ventricular rate in permanent atrial fibrillation: randomized, crossover study of the effects of slow-release formulations of gallopamil, diltiazem, or verapamil.
MedLine Citation:
PMID:  9825197     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The management of permanent atrial fibrillation (PAF) consists primarily of long-term anticoagulation with either aspirin or warfarin to prevent systemic embolization, and modulation of ventricular rate (VR) to improve cardiac function by prolonging the ventricular diastolic filling time. HYPOTHESIS: The effects of slow-release formulations of gallopamil (100 mg b.i.d.), diltiazem (120 mg b.i.d.), or verapamil (120 mg b.i.d.) on VR were evaluated in 18 patients with PAF without organic heart disease. METHODS: In all patients, each treatment was administered randomly, was compared with oral digoxin, and was assessed by 24-h Holter monitoring during daily life and by a 6-min walking test. RESULTS: There were no significant differences in mean and minimum VR recorded during 24-h Holter monitoring among the four treatments. Peak heart rates recorded during the 6-min walking test with digoxin treatment was 167 +/- 12 beats/min. This was significantly reduced by gallopamil (149 +/- 23 beats/min, p = 0.01), diltiazem (142 +/- 24 beats/min, p < 0.001), and verapamil (137 +/- 30 beats/min, p < 0.001). There were no significant differences in peak VR during the walking test among the three calcium antagonists. Pauses of > 3 s were observed in 3 of 18 (17%) patients who received digoxin (max 3.4 s) and in 5 of 18 (28%) patients who received diltiazem (max 3.4 s); p = NS. Periods of bradycardia < 30 beats/min were observed in 5 of 18 (28%) patients during digoxin treatment, and in 3 of 18 (17%) patients during treatment with gallopamil, diltiazem, and verapamil; p = NS. CONCLUSION: Gallopamil, diltiazem, or verapamil are superior to digoxin in controlling VR during mild exercise in patients with PAF without organic heart disease. The reduction of peak VR is obtainable without further slowing of resting VR. However, gallopamil appears to be the least effective calcium blocker at controlling resting and exercise VR; thus, there are no advantages over the other calcium blockers in its use in the clinical setting.
Authors:
G L Botto; W Bonini; T Broffoni
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Clinical cardiology     Volume:  21     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1999-01-27     Completed Date:  1999-01-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  837-40     Citation Subset:  IM    
Affiliation:
Department of Cardiology, St. Anna Hospital, Como, Italy.
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Aged
Anti-Arrhythmia Agents / administration & dosage,  pharmacology*
Atrial Fibrillation / drug therapy*,  physiopathology
Calcium Channel Blockers / pharmacology
Cardiotonic Agents / pharmacology
Cross-Over Studies
Delayed-Action Preparations
Digoxin / pharmacology
Diltiazem / administration & dosage,  pharmacology*
Electrocardiography, Ambulatory
Female
Gallopamil / administration & dosage,  pharmacology*
Heart Rate / drug effects*
Humans
Male
Middle Aged
Verapamil / administration & dosage,  pharmacology*
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/Calcium Channel Blockers; 0/Cardiotonic Agents; 0/Delayed-Action Preparations; 16662-47-8/Gallopamil; 20830-75-5/Digoxin; 42399-41-7/Diltiazem; 52-53-9/Verapamil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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