Use of Diltiazem in Chronic Rate Control for Atrial Fibrillation: A Prospective Case-Control Study

Abstract

Atrial fibrillation (AF) is a multifaceted disease requiring personalised treatment. The aim of our study was to explore the prognostic impact of a patient-specific therapy (PT) for rate control, including the use of non-dihydropyridine calcium channel blockers (NDDC) in patients with heart failure (HF) or in combination with beta-blockers (BB), compared to standard rate control therapy (ST), as defined by previous ESC guidelines. This is a single-centre prospective observational registry on AF patients who were followed by our University Hospital. We included 1112 patients on an exclusive rate control treatment. The PT group consisted of 125 (11.2%) patients, 93/125 (74.4%) of whom were prescribed BB + NDCC (±digoxin), while 85/125 (68.0%) were HF patients who were prescribed NDCC, which was diltiazem in all cases. The patients treated with a PT showed no difference in one-year overall survival compared to those with an ST. Notably, the patients with HF in ST had a worse prognosis (p < 0.001). To better define this finding, we performed three sensitivity analyses by matching each patient in the PT subgroups with three subjects from the ST cohort, showing an improved one-year survival of the HF patients treated with PT (p = 0.039). Our results suggest a potential outcome benefit of NDCC for rate control in AF patients, either alone or in combination with BB and in selected patients with HF.

Unraveling the Complexity: From Molecular Subtypes to Therapeutic Strategies in Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation

“…These results suggest that, disappointingly, spironolactone may not bring about significant enhancements in terms of boosting exercise tolerance and overall well-being for individuals dealing with atrial fibrillation who are on digoxin. However, itʹs interesting to observe that symptoms did show considerable differences between the groups, with many patients in the digoxin group reporting a noteworthy two-notch improvement [123,124] The use of bisoprolol in patients with heart failure showed clinical benefit in improving QoL . These findings suggest that the choice of rate control therapy in AF should consider factors beyond QoL alone.…”

Combined use of beta-blockers and non-dihydropyridine calcium channel blockers: possible or contraindicated?

“…Так, в работе Diemberger I, et al у пациентов с ФП и ХСН, получающих один из следующих вариантов лечения: БАБ в сочетании с дилтиаземом, БАБ в сочетании с дилтиаземом и дигоксином, дилтиазем или дилтиазем в сочетании с дигоксином в течение годичного наблюдения произошло 7 (8,2%) смертельных исходов, а в группе пациентов, получающих БАБ с дигоксином -47 (18,4%), p=0,039. На основании этих данных авторы сделали вывод о преимуществе дилтиазема для контроля ЧЖС у пациентов с ФП либо отдельно, либо в комбинации с БАБ, в т. ч. у отдельных пациентов с ХСН [38]. Вместе с тем полученные 2 https://scardio.ru/content/Guidelines/project/Proekt_FP_2023.pdf.…”

“…Кроме того, приводя информацию о функциональных классах ХСН, авторы не указывают частоту ХСН 3-4-го функциональных классов, а ограничиваются указанием того, что ХСН 2 и более функциональных классов встречалась в 95,3% случаев, а среднее значение ФВ ЛЖ составляло 49,1±16,0%. При этом авторы акцентируют внимание на необходимости дальнейших исследований в этой области [38].…”

Run baby run … but not too fast! Rate control management in atrial fibrillation: a claim for personalization

“…Unfortunately, we do not have an agent-specific sub-analysis, which in any case would present several limitations, to gather if these choices could have affected the final results. This could be relevant since the rate-control effect of beta-blockers is less pronounced when compared with non-dihydropyridine calcium-channel blockers, 9 and specific calcium-channel blockers may express a different level of negative inotropic effect, the latter being more pronounced with verapamil when compared with diltiazem. 10 Of note, we recently published the results of an analysis based on a cohort of AF patients showing that among the 1112 patients under rate-control treatment the group of 125 subjects treated with oral diltiazem presented good outcomes at long term, especially in selected patients with heart failure symptoms or with reduced left ventricular ejection fraction in the absence of haemodynamic compromise.…”