Preliminary investigation of the efficacy of sublingual verapamil in the management of acute atrial fibrillation and flutter.

Abstract

The antiarrhythmic properties of sublingual verapamil were investigated in seven patients with acute fast atrial flutter (n = 2) or fibrillation (n = 5). A rapid and significant (P < 0.05) reduction in the ventricular rate was achieved in all seven patients. The ventricular rate at peak plasma verapamil concentration (± s.d.) was significantly slower than on admission (101.6 ± 11.3 and 159 ± 5.3 beats min-I respectively, P < 0.01). The ventricular rate remained controlled for over 4 h. Sublingual verapamil was rapidly absorbed with the maximum peak plasma concentration (153.3 ± 15.5 ng ml-') being achieved after 1.21 ± 0.18 h. Side-effects of sublingual verapamil were limited to one report of a bitter taste. The sublingual administration of verapamil may provide an alternative method for the control of acute fast atrial fibrillation and flutter in selected patients.

Acute ventricular rate control in atrial fibrillation and atrial flutter

“…In another study, Shamroth and associates [10] reported 100% control of ventricular rates in atrial flutter and 97% in atrial fibrillation in response to a single dose of intravenous verapamil. According to the study by Fort and colleagues [11], sublingual administration of verapamil was found to provide an alternative method for the control of rapid ventricular response, and side effects of sublingual verapamil in this study were limited to one report of a bitter taste.…”

Treatment dilemmas in rapid atrial fibrillation

“…Most studies have examined intravenous verapamil or diltiazem 13,35–37 . Verapamil at a bolus dose of 0.075mg/kg to 0.15mg/kg effectively slows the rate in 85–95% of patients 13,36–38 . Verapamil has poor cardioversion rates of 12–15% and it cannot be recommended for this purpose 13,36,37 .…”

“…Verapamil has poor cardioversion rates of 12–15% and it cannot be recommended for this purpose 13,36,37 . Eighty milligrams of sublingual verapamil appears to be as effective as intravenous verapamil 38 . Hypotension is the most common adverse reaction and affects up to 50% of patients 13 .…”