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Updated: May 12, 2026
23:33
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Towards improved control of atrial fibrillation
European Heart Journal
|February 1, 1987
Summary
Adding verapamil to digoxin therapy significantly improved heart rate control in atrial fibrillation patients compared to higher digoxin doses alone. This combination reduced heart rate variability and nighttime bradycardia, with fewer patients experiencing toxic digoxin levels.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Atrial fibrillation (AF) management often involves digoxin, but it can lead to significant heart rate variability.
- Controlling heart rate variability is crucial for improving patient outcomes in AF.
Purpose of the Study:
- To compare the efficacy of doubling digoxin dosage versus adding verapamil for heart rate control in AF patients.
- To assess the impact of these interventions on heart rate variability, bradycardia, and patient-reported symptoms.
Main Methods:
- A randomized cross-over study involving 14 AF patients.
- Utilized 24-hour ambulatory ECG monitoring, six-minute walking tests, and symptom scoring.
- Compared high-dose digoxin against digoxin plus verapamil (120 mg daily).
Main Results:
- Both interventions lowered heart rate, but digoxin with verapamil resulted in less heart rate variability and reduced nighttime bradycardia.
- High-dose digoxin led to more frequent toxic serum levels (36% of patients) and prolonged daytime pauses.
- Palpitations were significantly reduced with the digoxin-verapamil combination.
Conclusions:
- Adding verapamil to digoxin is superior to increasing digoxin dose alone for managing heart rate variability in AF.
- The combination therapy offers better heart rate control with a reduced risk of adverse effects like nighttime bradycardia.
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