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Left Ventricular Performance During Acute Rate Control in Atrial Fibrillation: The Importance of Heart Rate and Agent Used

Paul Dorian, MD

Miney Paquette, MSc

Alvina Ng

Mark Burns, MD

Ileana Spanu, MD

Michael Freeman, MD, FACC

Victoria Korley, MD

Division of Cardiology, St. Michael's Hospital, University of Toronto, Canada

David Newman, MD, FACC

Division of Cardiology, St. Michael's Hospital, 30 Bond St. Room 7-051 Queen, Toronto, ON M5B lW8, Canada

Background: The relation between heart rate and left ventricular function during rate control in atrial fibrillation is incompletely understood.

Methods: Twenty-four patients (age 67 ± 11 years) with symptomatic recent onset rapid atrial fibrillation and rapid ventricular rate (> 110 bpm) were randomly assigned to receive either intravenous digoxin (13 mcg/kg) or intravenous diltiazem (0.25 mg/kg bolus plus a maintenance infusion). A portable radionuclide detector was used to collect validated measures of relative left ventricular volumes, along with heart rate data, every 15 seconds for 6 hours.

Results: Heart rate decreased significantly at 15 minutes and 180 minutes in the diltiazem group (from 133 ± 18 bpm to 111 ± 26 bpm [P < .01] to 94 ± 24 bpm [P < .001]) but not in the digoxin group (from 129 ± 18 bpm to 126 ± 17 bpm [P = NS] to 118 ± 15 bpm [P = NS]). Left ventricular ejection fraction improved in both groups to a similar extent (from 39 ± 10% to 50 ± 8%, [P < .05] after diltiazem, and from 38 ± 8% to 52 ± 11% [P < .05] after digoxin at baseline vs 180 minutes, respectively). The ejection fraction vs heart rate slope was steeper in the digoxin group than in the diltiazem group (-0.34 ± 0.18 vs -0.16 ± 0.17, P = .048) indicating a more pronounced improvement in ejection fraction per unit decrease in heart rate.

Conclusion: In patients with acute atrial fibrillation, digoxin led to similar improvements in ejection fraction compared to diltiazem despite a slower and less potent heart rate slowing.

Key Words: left ventricle • digoxin • diltiazem

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 8, No. 1, 17-24 (2003)
DOI: 10.1177/107424840300800i104


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				P. Dorian, I. Mangat, A. Pinter, and V. Korley The Burden of Atrial Fibrillation: Should We Abandon Antiarrhythmic Drug Therapy? Journal of Cardiovascular Pharmacology and Therapeutics, October 1, 2004; 9(4): 257 - 262. [Abstract] [PDF]