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Arrhythmias and sudden death
Original research
Rate control in atrial fibrillation, calcium channel blockers versus beta-blockers
  1. Tim Koldenhof1,2,
  2. Isabelle C Van Gelder2,
  3. Harry JGM Crijns3,
  4. Michiel Rienstra2,
  5. Robert G Tieleman1,2
  1. 1 Department of Cardiology, Martini Hospital, Groningen, The Netherlands
  2. 2 Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
  3. 3 Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
  1. Correspondence to Dr Michiel Rienstra, Department of Cardiology, University Medical Centre Groningen, Groningen, Groningen, Netherlands; m.rienstra{at}umcg.nl

Abstract

Objective To investigate heart rate differences between non-dihydropyridine calcium channel blockers and beta-blockers in patients with non-permanent atrial fibrillation (AF).

Methods Using data from ‘A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation’ (AFFIRM), where patients were randomised 1:1 rate or rhythm control, we compared the effect of rate control drugs on heart rate during AF as well as during sinus rhythm. Multivariable logistic regression was used to adjust for baseline characteristics.

Results A total of 4060 patients were enrolled in the AFFIRM trial, mean age was 70±9 years, 39% were women. Out of the total, 1112 patients were in sinus rhythm at baseline and used either non-dihydropyridine channel blockers or beta-blockers. Of them, 474 had AF during follow-up while remaining on the same rate control drugs, 218 (46%) on calcium channel blockers and 256 (54%) on beta-blockers. Mean age of calcium channel blocker patients was 70±8 years and 68±8 for beta-blocker patients (p=0.003), 42% were women. A resting heart rate <110 beats per min during AF was achieved in 92% of patients using calcium channel blockers and 92% of patients using beta-blockers (p=1.00). Bradycardia during sinus rhythm occurred in 17% of patients using calcium channel blockers vs 32% using beta-blockers (p<0.001). After adjusting for patient characteristics, calcium channel blockers were associated with a reduction in bradycardia during sinus rhythm (OR 0.41, 95% CI 0.19 to 0.90).

Conclusion In patients with non-permanent AF, calcium channel blockers instituted for rate control were associated with less bradycardia during sinus rhythm compared with beta-blockers.

  • atrial fibrillation
  • calcium channel blockers
  • bradycardia
  • tachycardia, supraventricular

Data availability statement

Data may be obtained from a third party and are not publicly available. This manuscript was prepared using AFFIRM research data obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Centre.

https://doi.org/10.1136/heartjnl-2023-322635

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. This manuscript was prepared using AFFIRM research data obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Centre.

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    Footnotes

    • Twitter @harry_crijns

    • Contributors TK was involved in the study design, data acquisition, conducted the statistical analyses and wrote the manuscript. MR and RGT were involved with the study design, data acquisition and interpretation of results and critically reviewed the manuscript. IVG and HJGMC were involved in the interpretation of the data and critically reviewed the manuscript. All authors approved the final version. RGT is the guarantor of this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests TK, ICVG and HJGMC have nothing to declare in relation to this paper. RGT reports grants from Medtronic and Abbott, and personal fees from Boehringer Ingelheim, Bayer and Pfizer/Bristol Meyer Squibb and is co-inventor of the MyDiagnostick, not receiving royalties for the past 5 years all outside the submitted work. MR reports consultancy fees from Bayer, Microport, InCarda Therapeutics to the institution all outside the submitted work.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.