Verapamil in atrial fibrillation and atrial flutter

Aronow, Wilbert S.; Landa, Daniel; Plasencia, Gilbert; Wong, Raymond Siu Ming; Karlsberg, Ronald P.; Ferlinz, Jack

doi:10.1002/cpt1979265578

Cited by 63 publications

(14 citation statements)

References 2 publications

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“…Verapamil was successful in 8-15% of patients. [14][15][16] Duration of fibrillation10 and the size of the left atrium' " influence the success of conversion. All the previously mentioned studies were largely performed in subjects with non-established paroxysmal or acute atrial fibrillation.9 16 Although the duration of fibrillation varied between studies, making comparison of the therapeutic effects difficult, fibrillation had not lasted more than one day in most patients.…”

Section: Discussionmentioning

confidence: 99%

Conversion of paroxysmal atrial fibrillation to sinus rhythm by intravenous pirmenol. A placebo controlled study.

Toivonen¹,

Nieminen²,

Manninen³

et al. 1986

Heart

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Section: Discussionmentioning

confidence: 99%

Conversion of paroxysmal atrial fibrillation to sinus rhythm by intravenous pirmenol. A placebo controlled study.

Toivonen¹,

Nieminen²,

Manninen³

et al. 1986

Heart

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“…As part of another protocol to assess efficacy of verapamil in long-term control of ventricular response, ten patients who had control but did not convert were begun on a regimen of oral verapamil in a dosage of 80 mg every six hours, of which three (patients 7, 9, and 12) converted to sinus rhythm within 24 hours of beginning administration. These patients all had atrial flutter of relatively short duration (one month, 17 hours, and 21 days, respectively). Figure 1 shows the response of MAP to the IV infusion of a single dose of verapamil in nonconverters.…”

Section: Resultsmentioning

confidence: 99%

Atrial fibrillation and flutter. Immediate control and conversion with intravenously administered verapamil

Tommaso¹,

McDonough²,

Parker³

et al. 1983

Archives of Internal Medicine

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The safety and efficacy of the intravenous (IV) calcium channel blocker, verapamil, in controlling the ventricular response or converting to sinus rhythm patients with atrial flutter or atrial fibrillation were assessed. Seventeen patients (nine with atrial flutter and eight with atrial fibrillation) with these arrhythmias that were difficult to control pharmacologically were chosen for the study. All patients at the time of study were receiving digoxin. Either verapamil or placebo was chosen randomly and a bolus of 0.075 mg/kg (up to 5 mg) was administered. Twelve patients had a marked reduction in their ventricular response after IV administration of verapamil (seven with atrial flutter and five with atrial fibrillation). None of these 12 patients converted (nonconverters). The average reduction in heart rate was from 120 +/- 6 beats per minute to a minimum of 83 +/- 13 beats per minute within 20 minutes after drug administration. Verapamil was found to convert five patients with atrial arrhythmias to sinus rhythm (two with atrial flutter and three with atrial fibrillation) (converters). In addition, three patients with atrial arrhythmias of less than one month who did not convert with parenteral drug therapy converted within 24 hours while receiving the oral drug. Converters had their supraventricular arrhythmias of significantly shorter duration (median, three hours v 30 days) and tended to have smaller left atrial size (3.8 +/- 0.7 cm v 4.3 +/- 1.3 cm) compared with the nonconverters. We conclude that verapamil is safe and effective when administered IV to patients with atrial flutter and fibrillation for control of ventricular response. In short duration atrial arrhythmias, conversion to sinus rhythm is likely once the ventricular response is controlled.

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“…Its use in the treatment of AF with a high ventricular rate is worldwide [28][29][30][31][32][33][34][35][36]. Recently [37,38] we have employed verapamil in 139 patients with AF of different etiologies.…”

Section: Verapamilmentioning

confidence: 99%

The pharmacologic treatment of atrial fibrillation

Bolognesi

1991

Cardiovasc Drug Ther

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The pharmacologic treatment of atrial fibrillation (AF) is aimed at controlling the ventricular response, restoring sinus rhythm, and preventing or delaying relapses. In the control of ventricular response, digitalis maintains a primary role when the arrhythmia is accompanied by heart failure. In ischemic, hypertensive, and degenerative (whose number is increasing at present) cardiopathies without evident ventricular dilatation, treatments with calcium antagonists (such as verapamil, gallopamil, or diltiazem) or beta-blocking agents must be preferred. In order to control the ventricular response in patients with chronic AF during physical activity, the association of digitalis with beta-blocking agents or calcium antagonists seems to provide satisfactory results. The drugs of the IC class, especially flecainide, represent a certain therapeutical progress in the restoration of sinus rhythm in the treatment of paroxysmal atrial fibrillation affecting subjects without evident alterations of ventricular function, particularly in subjects with Wolff-Parkinson-White syndrome, with forms of vagal origin, or with atrial fibrillation alone. A therapeutic combination of digitalis and quinidine may produce resolution of the arrhythmia in the presence of altered ventricular function or when AF is of an uncertain onset. In patients with hypertensive, ischemic, and/or degenerative cardiopathy without evident ventricular or advanced heart failure, the verapamil-quinidine association may also be effective and even quicker. The combination of drugs of the I and III class for restoration of the sinus rhythm in particularly resistant forms of AF without evident structural heart alterations is promising but must be verified in a greater number of patients. In the prevention of relapses amiodarone appears to have the widest spectrum of advantages from an electrophysiologic point of view; however, because of its many side effects, amiodarone represents a late therapeutical choice. The promising results obtained with flecainide are disputed by the results of the CAST, which limit the possibilities of using this drug to a low number of cases (W.P.W. syndrome, AF of vagal origin, atrial fibrillation alone). In the past, quinidine and disopyramide have been the drugs most widely used in the prophylaxis of AF. These drugs have a similar efficacy, and both of them provided some positive results. However, because of untoward side effects (especially for quinidine) during chronic treatment, the use of these drugs has been questioned. Perhaps in the majority of patients, the less dangerous therapeutic choice after the termination of the fibrillation is a combination of drugs slowly down AV node activity (digitalis or calcium antagonists and beta blockers) with class IA antiarrhythmics.

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Verapamil in atrial fibrillation and atrial flutter

Cited by 63 publications

References 2 publications

Conversion of paroxysmal atrial fibrillation to sinus rhythm by intravenous pirmenol. A placebo controlled study.

Conversion of paroxysmal atrial fibrillation to sinus rhythm by intravenous pirmenol. A placebo controlled study.

Atrial fibrillation and flutter. Immediate control and conversion with intravenously administered verapamil

The pharmacologic treatment of atrial fibrillation

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