Skip Navigation

Europace 2001 3(1):73-79; doi:10.1053/eupc.2000.0140
© 2001 by European Society of Cardiology
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (5)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Kochiadakis, G. E.
Right arrow Articles by Vardas, P. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kochiadakis, G. E.
Right arrow Articles by Vardas, P. E.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Sotalol vs metoprolol for ventricular rate control in patients with chronic atrial fibrillation who have undergone digitalization: a single-blinded crossover study

G. E. Kochiadakis, E. M. Kanoupakis, M. D. Kalebubas, N. E. Igoumenidis, K. E. Vardakis, H. E. Mavrakis and P. E. Vardas

Cardiology Department, University Hospital of Heraklion Crete, Greece

AIMS: To compare the effects of sotalol and metoprolol on heart rate, during isotonic (ITE) and isometric (IME) exercise and daily activities, in digitalized patients with chronic atrial fibrillation.

METHODS AND RESULTS: The study had a randomized, single-blinded, crossover design. Twenty-three patients with chronic atrial fibrillation received placebo for 4 weeks, followed by a 4-week period of treatment with sotalol and metoprolol in random order. At the end of each period, the patients were assessed with 24-h ECG monitoring, a cardiopulmonary exercise test and a handgrip manoeuvre.

Both agents produced a lower heart rate than placebo at rest and at all levels of isotonic exercise (P<0·001) without affecting oxygen uptake. Sotalol produced a lower heart rate than metoprolol only at submaximal exercise (116±9 bpm for sotalol vs 125±11 bpm for metoprolol, P<0·001). During isometric exercise, sotalol produced a lower maximum heart rate than did metoprolol (113±22 vs 129±18 bpm, respectively). Both agents produced a lower mean heart rate than placebo over 24 h (P<0·001 for all), while sotalol produced a lower mean heart rate than metoprolol during the daytime (P<0·01).

CONCLUSION: Sotalol is a safe and effective agent for control of heart rate in digitalized patients with atrial fibrillation. Sotalol is superior to metoprolol at submaximal exercise, resulting in better rate control during daily activities.

Key Words: Chronic atrial fibrillation, sotalol, metoprolol, exercise, Holter monitoring

Correspondence: Prof. P. E. Vardas, MD, PhD (London), FESC, FACC, Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia Heraklion, Crete, Greece. E-mail: cardio{at}med.uoc.gr

[1] David D, Segni ED, Klein HO, Kaplinsky E. Inefficacy of digitalis in the control of heart rate in patients with chronic atrial fibrillation: beneficial effect of an added beta adrenergic blocking agent. Am J Cardiol 1979; 44: 1378–1382.

[2] Atwood JE, Sullivan M, Forbes S, et al. Effect of beta-adrenergic blockade on exercise performance in patients with chronic atrial fibrillation. J Am Coll Cardiol 1987; 10: 314–320.

[3] Matsuda M, Matsuda Y, Yamagishi T, et al. Effects of digoxin, propranolol and verapamil on exercise in patients with chronic isolated atrial fibrillation. Cardiovasc Res 1991; 25: 453–457.

[4] Khalsa A, Edvardsson N, Olsson SB. Effects of metoprolol on heart rate in patients with digitalis treated chronic atrial fibrillation. Clin Cardiol 1978; 1: 91–95.

[5] Atwood JE, Myers J, Quaglietti S, Grumet J, Gianrossi R, Umman T. Effect of betaxolol on the hemodynamic, gas exchange, and cardiac output response to exercise in chronic atrial fibrillation. Chest 1999; 115: 1175–1180.

[6] Farshi R, Kistner D, Sarma JS, Longmate JA, Singh BN. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. J Am Coll Cardiol 1999; 33: 304–310.

[7] Hohnloser SH and Woosley RL. Sotalol. N Engl J Med 1994; 331: 31–38.

[8] Anderson JL and Prystowsky EN. Sotalol: An important new antiarrhythmic. Am Heart J 1999; 137: 388–409.

[9] Kowey PR, Marinchak RA, Rials SJ, Bharucha D. Pharmacologic and pharmacokinetic profile of class III antiarrhythmic drugs. Am J Cardiol 1997; 80: 16G–23G.

[10] Beaver WL, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 1986; 60: 2020–2027.

[11] Brodsky M, Saini R, Bellinger R, Zoble R, Weiss R, Powers L. Comparative effects of the combination of digoxin and dl-sotalol therapy versus digoxin monotherapy for control of ventricular response in chronic atrial fibrillation. dl-Sotalol Atrial Fibrillation Study Group. Am Heart J 1994; 127: 572–577.

[12] Singh S, Saini RK, DiMarco J, Kluger J, Gold R, Chen YW. Efficacy and safety of sotalol in digitalized patients with chronic atrial fibrillation. The Sotalol Study Group. Am J Cardiol 1991; 68: 1227–1230.

[13] Hsieh MH, Chen SA, Wen ZC, et al. Effects of antiarrhythmic drugs on variability of ventricular rate and exercise performance in chronic atrial fibrillation complicated with ventricular arrhythmias. Int J Cardiol 1998; 64: 37–45.

[14] Lok NS and Lau CP. Oxygen uptake kinetics and cardiopulmonary performance in lone atrial fibrillation and the effects of sotalol. Chest 1997; 111: 934–940.

[15] Nagayoshi H, Janota T, Hnatkova K, Camm AJ, Malik M. Autonomic modulation of ventricular rate in atrial fibrillation. Am J Physiol 1997; 272: H1643–1649.

[16] Hohnloser SH. Proarrhythmia with class III antiarrhythmic drugs: types, risks, and management. Am J Cardiol 1997; 80: 82G–89G.

[17] Reiffel JA. Impact of structural heart disease on the selection of class III antiarrhythmics for the prevention of atrial fibrillation and flutter. Am Heart J 1998; 135: 551–556.

[18] Van den Berg MP, De Langen CD, Crijns HJ, et al. Effect of metoprolol on atrial fibrillatory rate, atrioventricular nodal concealed conduction, and ventricular response during atrial fibrillation in pigs. J Cardiovasc Pharmacol 1994; 23: 846–851.

[19] Lewis RV, Irvine N, McDevitt DG. Relationships between heart rate, exercise tolerance and cardiac output in atrial fibrillation: the effects of treatment with digoxin, verapamil and diltiazem. Eur Heart J 1988; 9: 777–781.

[20] Goldman S, Probst P, Selzer A, Cohn K. Inefficacy of ‘therapeutic’ serum levels of digoxin in controlling the ventricular rate in atrial fibrillation. Am J Cardiol 1975; 35: 651–655.

[21] Lang R, Klein HO, Weiss E, et al. Superiority of oral verapamil therapy to digoxin in treatment of chronic atrial fibrillation. Chest 1983; 83: 491–499.

[22] Roth A, Harrison E, Mitani G, Cohen J, Rahimtoola SH, Elkayam U. Efficacy and safety of medium- and high-dose diltiazem alone and in combination with digoxin for control of heart rate at rest and during exercise in patients with chronic atrial fibrillation. Circulation 1986; 73: 316–324.

[23] Lang R, Klein HO, Di Segni E, et al. Verapamil improves exercise capacity in chronic atrial fibrillation: double-blind crossover study. Am Heart J 1983; 105: 820–825.

[24] Steinberg JS, Katz RJ, Bren GB, Buff LA, Varghese PJ. Efficacy of oral diltiazem to control ventricular response in chronic atrial fibrillation at rest and during exercise. J Am Coll Cardiol 1987; 9: 405–411.

[25] Lundstrom T and Ryden L. Ventricular rate control and exercise performance in chronic atrial fibrillation: effects of diltiazem and verapamil. J Am Coll Cardiol 1990; 16: 86–90.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Postgrad. Med. J.Home page
T Nikolaidou and K S Channer
Chronic atrial fibrillation: a systematic review of medical heart rate control management
Postgrad. Med. J., June 1, 2009; 85(1004): 303 - 312.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
T. Nikolaidou and K. S Channer
Rate control in permanent atrial fibrillation
BMJ, November 24, 2007; 335(7629): 1057 - 1058.
[Full Text] [PDF]

Home page
 EuropaceHome page
L. Mangin, A. Vinet, P. Pagé, and L. Glass
Effects of antiarrhythmic drug therapy on atrioventricular nodal function during atrial fibrillation in humans
Europace, January 1, 2005; 7(s2): S71 - S82.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (5)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Kochiadakis, G. E.
Right arrow Articles by Vardas, P. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kochiadakis, G. E.
Right arrow Articles by Vardas, P. E.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?