Left Ventricular Performance During Acute Rate Control in Atrial Fibrillation: The Importance of Heart Rate and Agent Used

Abstract

Background: The relation between heart rate and left ventricular function during rate control in atrial fibrillation is incompletely understood.

Methods: Twenty-four patients (age 67 ± 11 years) with symptomatic recent onset rapid atrial fibrillation and rapid ventricular rate (> 110 bpm) were randomly assigned to receive either intravenous digoxin (13 mcg/kg) or intravenous diltiazem (0.25 mg/kg bolus plus a maintenance infusion). A portable radionuclide detector was used to collect validated measures of relative left ventricular volumes, along with heart rate data, every 15 seconds for 6 hours.

Results: Heart rate decreased significantly at 15 minutes and 180 minutes in the diltiazem group (from 133 ± 18 bpm to 111 ± 26 bpm [P < .01] to 94 ± 24 bpm [P < .001]) but not in the digoxin group (from 129 ± 18 bpm to 126 ± 17 bpm [P = NS] to 118 ± 15 bpm [P = NS]). Left ventricular ejection fraction improved in both groups to a similar extent (from 39 ± 10% to 50 ± 8%, [P < .05] after diltiazem, and from 38 ± 8% to 52 ± 11% [P < .05] after digoxin at baseline vs 180 minutes, respectively). The ejection fraction vs heart rate slope was steeper in the digoxin group than in the diltiazem group (-0.34 ± 0.18 vs -0.16 ± 0.17, P = .048) indicating a more pronounced improvement in ejection fraction per unit decrease in heart rate.

Conclusion: In patients with acute atrial fibrillation, digoxin led to similar improvements in ejection fraction compared to diltiazem despite a slower and less potent heart rate slowing.