An Updated Review on the Role of Non-dihydropyridine Calcium Channel Blockers and Beta-blockers in Atrial Fibrillation and Acute Decompensated Heart Failure: Evidence and Gaps

Triska, Jeffrey; Tamargo, Juan; Bozkurt, Biykem; Elkayam, Uri; Taylor, Addison; Birnbaum, Yochai

doi:10.1007/s10557-022-07334-y

Cited by 4 publications

(3 citation statements)

References 69 publications

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“…In our cohort, about 11.2% of the patients were treated with a patient-specific therapy, including BB and NDCC in association and/or the use of NDCC in patients with HF, without any negative impact on the one-year survival. This is in line with the consideration that data suggesting a contraindication of NDCC in HF with a reduced LVEF are outdated, and the related studies were not primarily designed to address the efficacy and safety of rate control of AF in patients with HF [15]. In this regard, it is noteworthy that we found signals of the possible positive effects of a patient-specific therapy, including NDCC in selected patients.…”

Section: Discussionsupporting

confidence: 77%

“…Looking at the literature, we can find small studies showing the safety and efficacy of diltiazem in the acute rate control of AF or flutter with moderate to severe HF [24,26,27]. However, the data on the efficacy and safety of the long-term use of NDCC in patients with AF and an ejection fraction < 40% are lacking [15]. This is mainly due to the habit of avoiding NDCC in patients with HF.…”

Section: Discussionmentioning

confidence: 99%

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

Diemberger

Spadotto

Massaro

et al. 2022

Biology

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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.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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

Diemberger

Spadotto

Massaro

et al. 2022

Biology

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“…However, these data are in line with the suggestion to reconsider the role of non-dihydropyridine calcium-channel drugs for rate control of AF, 11 in view of their positive effects on exercise capacity and NT-pro BNP compared with beta-blockers 12 and taking into account that the strict contraindication to calcium-channel blockers for rate control in AF patients with heart failure patients and/or reduced ejection fraction was derived from outdated studies, not primarily designed to address the efficacy and safety of rate control in AF patients with heart failure. 13 …”

mentioning

confidence: 99%

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

Diemberger

Boriani

2023

Europace

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Pathophysiology and treatment of adults with arrhythmias in the emergency department, part 1: Atrial arrhythmias

Ray

Geier

DeWitt

2023

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose This article, the first in a 2-part review, aims to reinforce current literature on the pathophysiology of cardiac arrhythmias and various evidence-based treatment approaches and clinical considerations in the acute care setting. Part 1 of this series focuses on atrial arrhythmias. Summary Arrhythmias are prevalent throughout the world and a common presenting condition in the emergency department (ED) setting. Atrial fibrillation (AF) is the most common arrhythmia worldwide and expected to increase in prevalence. Treatment approaches have evolved over time with advances in catheter-directed ablation. Based on historic trials, heart rate control has been the long-standing accepted outpatient treatment modality for AF, but the use of antiarrhythmics is often still indicated for AF in the acute setting, and ED pharmacists should be prepared and poised to help manage. Other atrial arrhythmias include atrial flutter (AFL), atrioventricular nodal reentry tachycardia (AVNRT), and atrioventricular reentrant tachycardia (AVRT), which warrant distinction due to their unique pathophysiology and because each requires a different approach to utilization of antiarrhythmics. Atrial arrhythmias are typically associated with greater hemodynamic stability than ventricular arrhythmias but still require nuanced management according to patient subset and risk factors. Since antiarrhythmics can also be proarrhythmic, they may destabilize the patient due to adverse effects, many of which are the focus of black-box label warnings that can be overreaching and limit treatment options. Electrical cardioversion for atrial arrhythmias is generally successful and, depending on the setting and/or hemodynamics, often indicated. Conclusion Atrial arrhythmias arise from a variety of mechanisms, and appropriate treatment depends on various factors. A firm understanding of physiological and pharmacological concepts serves as a foundation for exploring evidence supporting agents, indications, and adverse effects in order to provide appropriate care for patients.

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An Updated Review on the Role of Non-dihydropyridine Calcium Channel Blockers and Beta-blockers in Atrial Fibrillation and Acute Decompensated Heart Failure: Evidence and Gaps

Cited by 4 publications

References 69 publications

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

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

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

Pathophysiology and treatment of adults with arrhythmias in the emergency department, part 1: Atrial arrhythmias

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