TY - JOUR
T1 - Rate control drugs differ in the prevention of progression of atrial fibrillation
AU - Koldenhof, Tim
AU - Wijtvliet, Petra E. P. J.
AU - Pluymaekers, Nikki A. H. A.
AU - Rienstra, Michiel
AU - Folkeringa, Richard J.
AU - Bronzwaer, Patrick
AU - Elvan, Arif
AU - Elders, Jan
AU - Tukkie, Raymond
AU - Luermans, Justin G. L. M.
AU - van Kuijk, Sander M. J.
AU - Tijssen, Jan G. P.
AU - van Gelder, Isabelle C.
AU - Crijns, Harry J. G. M.
AU - Tieleman, Robert G.
N1 - Publisher Copyright: © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Aims: We hypothesize that in patients with paroxysmal atrial fibrillation (AF), verapamil is associated with lower AF progression compared to beta blockers or no rate control. Methods and results: In this pre-specified post hoc analysis of the RACE 4 randomized trial, the effect of rate control medication on AF progression in paroxysmal AF was analysed. Patients using Vaughan-Williams Class I or III antiarrhythmic drugs were excluded. The primary outcome was a composite of first electrical cardioversion (ECV), chemical cardioversion (CCV), or atrial ablation. Event rates are displayed using Kaplan-Meier curves and multivariable Cox regression analyses are used to adjust for baseline differences. Out of 666 patients with paroxysmal AF, 47 used verapamil, 383 used beta blockers, and 236 did not use rate control drugs. The verapamil group was significantly younger than the beta blocker group and contained more men than the no rate control group. Over a mean follow-up of 37 months, the primary outcome occurred in 17% in the verapamil group, 33% in the beta blocker group, and 33% in the no rate control group (P = 0.038). After adjusting for baseline characteristics, patients using verapamil have a significantly lower chance of receiving ECV, CCV, or atrial ablation compared to patients using beta blockers [hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.19-0.83] and no rate control (HR 0.64, 95% CI 0.44-0.93). Conclusion: In patients with newly diagnosed paroxysmal AF, verapamil was associated with less AF progression, as compared to beta blockers and no rate control.
AB - Aims: We hypothesize that in patients with paroxysmal atrial fibrillation (AF), verapamil is associated with lower AF progression compared to beta blockers or no rate control. Methods and results: In this pre-specified post hoc analysis of the RACE 4 randomized trial, the effect of rate control medication on AF progression in paroxysmal AF was analysed. Patients using Vaughan-Williams Class I or III antiarrhythmic drugs were excluded. The primary outcome was a composite of first electrical cardioversion (ECV), chemical cardioversion (CCV), or atrial ablation. Event rates are displayed using Kaplan-Meier curves and multivariable Cox regression analyses are used to adjust for baseline differences. Out of 666 patients with paroxysmal AF, 47 used verapamil, 383 used beta blockers, and 236 did not use rate control drugs. The verapamil group was significantly younger than the beta blocker group and contained more men than the no rate control group. Over a mean follow-up of 37 months, the primary outcome occurred in 17% in the verapamil group, 33% in the beta blocker group, and 33% in the no rate control group (P = 0.038). After adjusting for baseline characteristics, patients using verapamil have a significantly lower chance of receiving ECV, CCV, or atrial ablation compared to patients using beta blockers [hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.19-0.83] and no rate control (HR 0.64, 95% CI 0.44-0.93). Conclusion: In patients with newly diagnosed paroxysmal AF, verapamil was associated with less AF progression, as compared to beta blockers and no rate control.
KW - Atrial fibrillation
KW - Atrial fibrillation progression
KW - RACE 4 study
KW - Rate control
KW - Rhythm control
UR - http://www.scopus.com/inward/record.url?scp=85126596990&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/europace/euab191
DO - https://doi.org/10.1093/europace/euab191
M3 - Article
C2 - 34414430
SN - 1099-5129
VL - 24
SP - 384
EP - 389
JO - Europace
JF - Europace
IS - 3
ER -