Rate control in atrial fibrillation

Gelder, Isabelle C. Van; Rienstra, Michiel; Crijns, Harry J.G.M.; Olshansky, Brian

doi:10.1016/s0140-6736(16)31258-2

Cited by 142 publications

(71 citation statements)

References 92 publications

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“…The inhibited Na + /K + ATPase results in a higher concentration of intracellular calcium which leads to an increase in the left ventricular systolic function [40]. The heart rate is decreased by inducing vagal activation which presumably slows down the conduction of the atrioventricular node, consequently lowering the heart rate [41]. …”

Section: Description Of the Interventionmentioning

confidence: 99%

“…Beta-blockers (Vaughan Williams class II) block the sympathetic activity in the atrioventricular node, consequently decreasing the heart rate [41]. The different beta-blockers are illustrated in Table 2.…”

Section: Description Of the Interventionmentioning

confidence: 99%

“…Non-dihydropyridine calcium channel blockers (Vaughan Williams class IV) slow the atrioventricular node conduction by blocking calcium channels and thus lower the heart rate [41]. The main non-dihydropyridine calcium channel blockers are illustrated in Table 2.…”

Section: Description Of the Interventionmentioning

confidence: 99%

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Digoxin versus placebo, no intervention, or other medical interventions for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis

et al. 2017

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BackgroundAtrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2% in the western world. Atrial flutter, another arrhythmia, occurs less often with an incidence of approximately 200,000 new patients per year in the USA. Patients with atrial fibrillation and atrial flutter have an increased risk of death and morbidities. In the management of atrial fibrillation and atrial flutter, it is often necessary to use medical interventions to lower the heart rate. Lowering the heart rate may theoretically prevent the development of heart failure and tachycardia-mediated cardiomyopathy. The evidence on the benefits and harms of digoxin compared with placebo or with other medical interventions is unclear. This protocol for a systematic review aims at identifying the beneficial and harmful effects of digoxin compared with placebo, no intervention, or with other medical interventions for atrial fibrillation and atrial flutter.MethodsThis protocol for a systematic review was conducted following the recommendations of Cochrane and the eight-step assessment procedure suggested by Jakobsen and colleagues. We plan to include all relevant randomised clinical trials comparing digoxin with placebo, no intervention, or with other medical interventions. We plan to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, Science Citation Index Expanded on Web of Science, and BIOSIS to identify relevant trials. Any eligible trial will be assessed and classified as either at high risk of bias or low risk of bias, and our primary conclusions will be based on trials with low risk of bias. We will perform our meta-analyses of the extracted data using Review Manager 5.3 and Trial Sequential Analysis ver. 0.9.5.5 beta. For both our primary and secondary outcomes, we will create a ‘Summary of Findings’ table based on GRADE assessments of the quality of the evidence.DiscussionThe results of this systematic review have the potential to benefit millions of patients worldwide as well as healthcare economy.Systematic review registrationPROSPERO CRD42016052935Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0470-2) contains supplementary material, which is available to authorized users.

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Section: Description Of the Interventionmentioning

confidence: 99%

Section: Description Of the Interventionmentioning

confidence: 99%

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Digoxin versus placebo, no intervention, or other medical interventions for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis

et al. 2017

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“…Pharmacological management of heart rate, the mainstay of treatment in patients with atrial fibrillation (AF), is subjected to ongoing controversy 1. Two important questions yet to be answered in rate control therapy are; what constitutes the optimal heart rate during AF and which rate controlling drug should be instituted in the individual patient.…”

Section: Contextmentioning

confidence: 99%

“…It is central to AF management and should be background therapy in all patients with AF. Until data from randomised controlled trials are available the choice of rate controlling drugs alone or in combinations, should be individualised and instituted carefully 1. Dosages may be modulated during the course of the disease, as comorbidities and conduction disturbances may either develop or advance.…”

Section: Implications For Practicementioning

confidence: 99%

Still many unanswered questions about rate control therapy in atrial fibrillation

Kloosterman

Gelder

2016

Evid Based Med

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Serious Bleeding in Patients With Atrial Fibrillation Using Diltiazem With Apixaban or Rivaroxaban

Ray,

Chung,

Stein

et al. 2024

JAMA

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ImportanceDiltiazem, a commonly prescribed ventricular rate–control medication for patients with atrial fibrillation, inhibits apixaban and rivaroxaban elimination, possibly causing overanticoagulation.ObjectiveTo compare serious bleeding risk for new users of apixaban or rivaroxaban with atrial fibrillation treated with diltiazem or metoprolol.Design, Setting, and ParticipantsThis retrospective cohort study included Medicare beneficiaries aged 65 years or older with atrial fibrillation who initiated apixaban or rivaroxaban use and also began treatment with diltiazem or metoprolol between January 1, 2012, and November 29, 2020. Patients were followed up to 365 days through November 30, 2020. Data were analyzed from August 2023 to February 2024.ExposuresDiltiazem and metoprolol.Main Outcomes and MeasuresThe primary outcome was a composite of bleeding-related hospitalization and death with recent evidence of bleeding. Secondary outcomes were ischemic stroke or systemic embolism, major ischemic or hemorrhagic events (ischemic stroke, systemic embolism, intracranial or fatal extracranial bleeding, or death with recent evidence of bleeding), and death without recent evidence of bleeding. Hazard ratios (HRs) and rate differences (RDs) were adjusted for covariate differences with overlap weighting.ResultsThe study included 204 155 US Medicare beneficiaries, of whom 53 275 received diltiazem and 150 880 received metoprolol. Study patients (mean [SD] age, 76.9 [7.0] years; 52.7% female) had 90 927 person-years (PY) of follow-up (median, 120 [IQR, 59-281] days). Patients receiving diltiazem treatment had increased risk for the primary outcome (RD, 10.6 [95% CI, 7.0-14.2] per 1000 PY; HR, 1.21 [95% CI, 1.13-1.29]) and its components of bleeding-related hospitalization (RD, 8.2 [95% CI, 5.1-11.4] per 1000 PY; HR, 1.22 [95% CI, 1.13-1.31]) and death with recent evidence of bleeding (RD, 2.4 [95% CI, 0.6-4.2] per 1000 PY; HR, 1.19 [95% CI, 1.05-1.34]) compared with patients receiving metoprolol. Risk for the primary outcome with initial diltiazem doses exceeding 120 mg/d (RD, 15.1 [95% CI, 10.2-20.1] per 1000 PY; HR, 1.29 [95% CI, 1.19-1.39]) was greater than that for lower doses (RD, 6.7 [95% CI, 2.0-11.4] per 1000 PY; HR, 1.13 [95% CI, 1.04-1.24]). For doses exceeding 120 mg/d, the risk of major ischemic or hemorrhagic events was increased (HR, 1.14 [95% CI, 1.02-1.27]). Neither dose group had significant changes in the risk for ischemic stroke or systemic embolism or death without recent evidence of bleeding. When patients receiving high- and low-dose diltiazem treatment were directly compared, the HR for the primary outcome was 1.14 (95% CI, 1.02-1.26).Conclusions and RelevanceIn Medicare patients with atrial fibrillation receiving apixaban or rivaroxaban, diltiazem was associated with greater risk of serious bleeding than metoprolol, particularly for diltiazem doses exceeding 120 mg/d.

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Rate control in atrial fibrillation

Cited by 142 publications

References 92 publications

Digoxin versus placebo, no intervention, or other medical interventions for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis

Digoxin versus placebo, no intervention, or other medical interventions for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis

Still many unanswered questions about rate control therapy in atrial fibrillation

Serious Bleeding in Patients With Atrial Fibrillation Using Diltiazem With Apixaban or Rivaroxaban

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