VERDICT: The Verapamil versus Digoxin Cardioversion Trial: A Randomized Study on the Role of Calcium Lowering for Maintenance of Sinus Rhythm after Cardioversion of Persistent Atrial Fibrillation

Noord, T Van; Gelder, IC Van; Tieleman, RG; Bosker, Hans A.; Tuinenburg, AE; Volkers, C; Veeger, Njgm; Crijns, Hjgm

doi:10.1046/j.1540-8167.2001.00766.x

Cited by 69 publications

(34 citation statements)

References 4 publications

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“…In patients with persistent AF, treatment with verapamil 1 mo before and after direct-current cardioversion did not improve the outcome of cardioversion. 716 …”

Section: Fuster Et Al Acc/aha/esc Practice Guidelines E313mentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,882

589

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“…In patients with persistent AF, treatment with verapamil 1 mo before and after direct-current cardioversion did not improve the outcome of cardioversion. 716 …”

Section: Fuster Et Al Acc/aha/esc Practice Guidelines E313mentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,882

589

View full text Add to dashboard Cite

“…4 It should be emphasized that this argument is unlikely to apply to late recurrence of the arrhythmias. 15 Our findings suggest that pharmacological reduction of atrial AF rate (with flecainide or ibutilide) and a reduction of calcium loading (as with verapamil) may be worthwhile strategies to consider in attempting to prevent IRAF in the clinic. …”

mentioning

confidence: 76%

“…15 Indeed, a transient period of hypercontractility has been shown to occur immediately after termination of relatively short (Յ30 minutes) but not after long periods of AF in porcine atria in vivo. 16 Vagotonic AF is believed to be uncommon in clinical practice 11 ; accordingly, due caution must be exercised in extrapolating to humans the mechanism of reinduction of AF observed in presence of ACh in isolated canine right atria.…”

Section: Study Limitationsmentioning

confidence: 99%

Reinduction of Atrial Fibrillation Immediately After Termination of the Arrhythmia Is Mediated by Late Phase 3 Early Afterdepolarization–Induced Triggered Activity

2003

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Background-Atrial fibrillation (AF) at times recurs immediately after termination of the arrhythmia. The mechanism (s) responsible for the extrasystole that reinduces AF is largely unknown. We hypothesized that abbreviation of action potential duration (APD) would permit very rapid rates of excitation, known to induce intracellular calcium loading, which in turn could promote delayed and/or early afterdepolarizations (EADs). Methods and Results-Acetylcholine (ACh, 1 mol/L) was used to abbreviate atrial APD and permit rapid-pacing induction of AF in isolated coronary-perfused canine right atria. Transmembrane action potentials, pseudo-ECG, and tension development were recorded. AF or rapid pacing was associated with an increase in tonic tension. Termination of AF or rapid pacing (cycle length, 150 to 80 ms) resulted in a dramatic rise of phasic tension, prolongation of repolarization of the initial beats at the regular rate (cycle length, 700 ms), and the development of late phase 3 EADs and extrasystoles. These extrasystoles initiated AF in 15 cases (involving 9 right atria) within the first 11 seconds after termination of AF or rapid pacing. This novel EAD mechanism is observed only in association with marked APD abbreviation. The calcium channel blocker nifedipine reduced, and the sarcoplasmic reticulum calcium release blocker ryanodine eliminated, the post-rapid pacing-induced increase in phasic tension, late phase 3 EADs, and extrasystoles that initiate AF. Conclusions-These data suggest that calcium overload conditions present after termination of vagally mediated AF contribute to the development of late phase 3 EAD-induced triggered activity and that this mechanism may be responsible for the extrasystolic activity that reinitiates AF. Key Words: action potentials Ⅲ fibrillation Ⅲ calcium Ⅲ triggered activity A number of studies have documented the reinitiation of atrial fibrillation (AF) by an atrial extrasystole arising soon after termination of the arrhythmia. [1][2][3][4] Although a reentrant mechanism is thought to underlie the maintenance of the arrhythmia, the mechanism(s) responsible for the premature beat(s) that reinduce AF is largely unknown. Immediate recurrence of AF (IRAF) was found to be unexpectedly high in patients with implanted atrial defibrillators, occurring after 27% of successful shocks. 5 Patients who experience early AF recurrence after cardioversion have been shown to display briefer mean AF cycle lengths (CLs) than those who do not. 6 In addition, acute treatment with the calcium channel blocker verapamil has been shown to reduce IRAF after electrical cardioversion in the clinic. 4 These observations highlight the importance of rapid rates and calcium homeostasis in the early reinitiation of AF.Like electrical remodeling, 7 vagal influences are known to cause a marked abbreviation of atrial action potential duration (APD), permitting activation of atrial cells at much higher frequencies than otherwise possible. We hypothesized that immediately after termination of these rapid ra...

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“…In patients with persistent AF, treatment with verapamil 1 mo before and after direct-current cardioversion did not improve the outcome of cardio-version. 716 …”

Section: Nondihydropyridine Calcium Channel Antagonistsmentioning

confidence: 99%

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2011

Circulation

809

463

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VERDICT: The Verapamil versus Digoxin Cardioversion Trial: A Randomized Study on the Role of Calcium Lowering for Maintenance of Sinus Rhythm after Cardioversion of Persistent Atrial Fibrillation

Abstract: Stand-alone intracellular calcium lowering by verapamil around ECV does not enhance cardioversion outcome.

Cited by 69 publications

References 4 publications

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Reinduction of Atrial Fibrillation Immediately After Termination of the Arrhythmia Is Mediated by Late Phase 3 Early Afterdepolarization–Induced Triggered Activity

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

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