VERDICT: the Verapamil versus Digoxin Cardioversion Trial: A randomized study on the role of calcium lowering for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation.
BACKGROUND
Many relapses of atrial fibrillation (AF) occur, especially during the first week(s) after electrical cardioversion (ECV). The aim of the present study was to compare in a randomized design the efficacy of verapamil (intracellular calcium lowering) versus digoxin (calcium increasing) for maintenance of sinus rhythm after ECV.


RESULTS
Ninety-seven patients with persistent AF were randomized to verapamil (n = 49) or digoxin (n = 48) for 1 month before and 1 month after ECV. The first month after ECV, patients recorded heart rhythm using daily transtelephonic monitoring. No additional antiarrhythmic drugs were given. Of the 97 patients, 43 patients (20 verapamil) underwent ECV per protocol. Median previous AF duration was 18 and 26 days for verapamil and digoxin, respectively. There were no differences in atrial dimensions and underlying heart disease between the two groups. The success rate of ECV was 75% versus 83% (P = NS). After 1 month, 47% versus 53% (P = NS) had recurrence of AF. Median time to recurrence was 5 days (range 0 to 26) versus 8 days (range 2 to 28) (P = NS), respectively.


CONCLUSIONS
Stand-alone intracellular calcium lowering by verapamil around ECV does not enhance cardioversion outcome.
Van Noord
T
T
Department of Cardiology, Thoraxcenter, University Hospital Groningen, The Netherlands.
Van Gelder
I C
IC
Tieleman
R G
RG
Bosker
H A
HA
Tuinenburg
A E
AE
Volkers
C
C
Veeger
N J
NJ
Crijns
H J
HJ
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D002118:Calcium / Q000378:metabolism; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use*; D004554:Electric Countershock; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014700:Verapamil / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D004077:Digoxin; D014700:Verapamil; D002118:Calcium