Role of verapamil in atrial fibrillation: effect on trigger or on substrate? Data from the VeRAF study

Botto, Giovanni Luca; Belotti, Giuseppina; Cirò, Antonio; Ziacchi, Vigilio; Romanò, Massimo; Pala, Massimo; Sagone, Antonio; Pitì, Antonino; Vincenti, Antonello; Gelmini, Giampaolo

doi:10.1016/s0735-1097(02)80353-9

Cited by 3 publications

(6 citation statements)

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“…In the studies from De Simone et al, 2,3 verapamil administered with an abbreviated dosing regime, beginning 3 days prior to cardioversion, demonstrated improved maintenance of SR when combined with propafenone 2 or amiodarone 3 . Several studies have examined the clinical utility of verapamil as a stand alone agent in prevention of AF recurrences 4–6 . All of the studies used a longer dosing schedule to that of De Simone and none found a sustained improvement over the period of follow‐up (1–3 months); however, even with pretreatment, the beneficial effects of verapamil are short lived and are absent by 1 week 23 .…”

Section: Discussionmentioning

confidence: 99%

“…3 Several studies have examined the clinical utility of verapamil as a stand alone agent in prevention of AF recurrences. [4][5][6] All of the studies used a longer dosing schedule to that of De Simone and none found a sustained improvement over the period of follow-up (1-3 months); however, even with pretreatment, the beneficial effects of verapamil are short lived and are absent by 1 week. 23 Thus timing of verapamil dosing may be clinically important.…”

Section: Verapamil Use In Afmentioning

confidence: 99%

“…The mechanism by which this benefit was achieved is not known. In other studies that used a longer dosing regimen, verapamil as a stand alone agent did not reproduce these findings 4–6 . Thus it is not known if the beneficial effect of verapamil is related to a synergistic action with an antiarrhythmic drug or perhaps an intrinsic action apparent only when employing an abbreviated dosing regime.…”

Section: Introductionmentioning

confidence: 97%

“…In other studies that used a longer dosing regimen, verapamil as a stand alone agent did not reproduce these findings. [4][5][6] Thus it is not known if the beneficial effect of verapamil is related to a synergistic action with an antiarrhythmic drug or per-haps an intrinsic action apparent only when employing an abbreviated dosing regime. Moreover the effect of verapamil on atrial electrophysiologic substrate is uncertain with studies delivering apparently contradictory results on fibrillatory interval (as a measure of atrial effective refractory period) 7,8 and trigger burden.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover the effect of verapamil on atrial electrophysiologic substrate is uncertain with studies delivering apparently contradictory results on fibrillatory interval (as a measure of atrial effective refractory period) 7,8 and trigger burden. 4,9 Our objective was to determine if the results obtained with verapamil using an abbreviated dosing regime could be reproduced when verapamil was used as a stand alone "antiarrhythmic agent." We hypothesized serial evaluation of the signalaveraged P wave (SAPW) might reflect change in atrial electrophysiologic substrate if present when compared with a control group not receiving verapamil.…”

Section: Introductionmentioning

confidence: 99%

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Signal‐Averaged P Wave Reflects Change in Atrial Electrophysiological Substrate Afforded by Verapamil Following Cardioversion from Atrial Fibrillation

Redfearn

Skanes

Lane

et al. 2006

Pacing Clinical Electrophis

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Section: Discussionmentioning

confidence: 99%

Section: Verapamil Use In Afmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Signal‐Averaged P Wave Reflects Change in Atrial Electrophysiological Substrate Afforded by Verapamil Following Cardioversion from Atrial Fibrillation

Redfearn

Skanes

Lane

et al. 2006

Pacing Clinical Electrophis

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Verapamil plus antiarrhythmic drugs reduce atrial fibrillation recurrences after an electrical cardioversion (VEPARAF study)

Simone¹,

Pasquale²,

Matteis³

2004

ACC Current Journal Review

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AimsTo evaluate the impact, on atrial fibrillation (AF) recurrences, of verapamil addition to a class IC or III antiarrhythmic drug in patients, with persistent AF, who underwent an electrical cardioversion (EC). Methods and results Three hundred sixty-three patients were randomized to receive four different pre-treatment protocols: oral amiodarone (group A), oral flecainide (group F), oral amiodarone plus oral verapamil (group A+V), oral flecainide plus oral verapamil (group F+V). Patients who showed an AF recurrence within 3 months were assigned to the alternative group and underwent a second EC after 48 h. During 3 months of follow-up, 89 patients (27.5%) had an AF recurrence. By univariate analysis, verapamil reduced AF recurrences if added to amiodarone or flecainide (from 35% to 20%, P=0.004). Applying Cox proportional hazards regression model, only the younger age, the shorter duration of AF, and the use of verapamil were predictor of maintenance of sinus rhythm after cardioversion. In patients with primary AF recurrence, verapamil addition to group A and F patients, significantly decreased secondary AF recurrence rate as compared to group A+V and F+V patients who stopped the verapamil therapy (68% vs 88%, P=0.03). Conclusions The addition of verapamil to class IC or III antiarrhythmic drug significantly reduced the AF recurrences, that were more frequent in older patients and in patients with longer lasting AF; moreover, verapamil was effective in reducing the secondary AF recurrences, too.

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Adjuvant Therapy for Atrial Fibrillation

2009

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Atrial fibrillation (AF) is the most common heart rhythm disorder, with increasing prevalence in the aging US population and affecting more than 2.3 million people. Current approaches for managing AF are rate- or rhythm-control strategies, both using anti-thrombotic therapy to prevent thromboembolism. While great advances have been made in understanding the pathophysiology of AF, few new strategies have shown promise in prevention or treatment of AF. Recent data suggest that non-antiarrhythmic medication may be useful in modifying the substrate that allows AF precipitation and perpetuation. This article reviews the data on the role of these agents in the prevention and management of AF as an adjunct to standard therapy.

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Role of verapamil in atrial fibrillation: effect on trigger or on substrate? Data from the VeRAF study

Cited by 3 publications

References 0 publications

Signal‐Averaged P Wave Reflects Change in Atrial Electrophysiological Substrate Afforded by Verapamil Following Cardioversion from Atrial Fibrillation

Signal‐Averaged P Wave Reflects Change in Atrial Electrophysiological Substrate Afforded by Verapamil Following Cardioversion from Atrial Fibrillation

Verapamil plus antiarrhythmic drugs reduce atrial fibrillation recurrences after an electrical cardioversion (VEPARAF study)

Adjuvant Therapy for Atrial Fibrillation

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