title: Verapamil versus digoxin and acute versus routine serial cardioversion for the improvement of rhythm control for persistent atrial fibrillation.
abstract: OBJECTIVE
  The VERDICT (Verapamil Versus Digoxin and Acute Versus Routine Serial Cardioversion Trial) is a prospective, randomized study to investigate whether: 1) acutely repeated serial electrical cardioversions (ECVs) after a relapse of atrial fibrillation (AF); and 2) prevention of intracellular calcium overload by verapamil, decrease intractability of AF.
  
  
  BACKGROUND
  Rhythm control is desirable in patients suffering from symptomatic AF.
  
  
  METHODS
  A total of 144 patients with persistent AF were included. Seventy-four (51%) patients were randomized to the acute (within 24 h) and 70 (49%) patients to the routine serial ECVs, and 74 (51%) patients to verapamil and 70 (49%) patients to digoxin for rate control before ECV and continued during follow-up (2 x 2 factorial design). Class III antiarrhythmic drugs were used after a relapse of AF. Follow-up was 18 months.
  
  
  RESULTS
  At baseline, there were no significant differences between the groups, except for beta-blocker use in the verapamil versus digoxin group (38% vs. 60%, respectively, p = 0.01). At follow-up, no difference in the occurrence of permanent AF between the acute and the routine cardioversion groups was observed (32% [95% confidence intervals (CI)] 22 to 44) vs. 31% [95% CI 21 to 44], respectively, p = NS), and also no difference between the verapamil- and the digoxin-randomized patients (28% [95% CI 19 to 40] vs. 36% [95% CI 25 to 48] respectively, p = NS). Multivariate Cox regression analysis revealed that lone digoxin use was the only significant predictor of failure of rhythm control treatment (hazard ratio 2.2 [95% CI 1.1 to 4.4], p = 0.02).
  
  
  CONCLUSIONS
  An acute serial cardioversion strategy does not improve long-term rhythm control in comparison with a routine serial cardioversion strategy. Furthermore, verapamil has no beneficial effect in a serial cardioversion strategy.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Martin E W
authors.initials: ME
authors.lastname: Hemels
authors.forename: Trudeke
authors.initials: T
authors.lastname: Van Noord
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Van Veldhuisen
authors.forename: Nic J G M
authors.initials: NJ
authors.lastname: Veeger
authors.forename: Hans A
authors.initials: HA
authors.lastname: Bosker
authors.forename: Ans C P
authors.initials: AC
authors.lastname: Wiesfeld
authors.forename: Maarten P
authors.initials: MP
authors.lastname: Van den Berg
authors.forename: Adelita V
authors.initials: AV
authors.lastname: Ranchor
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: Van Gelder
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000628:therapy*; D002118:Calcium / Q000378:metabolism; D004077:Digoxin / Q000627:therapeutic use*; D004554:Electric Countershock; D005260:Female; D006470:Hemorrhage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D013923:Thromboembolism; D016896:Treatment Outcome; D014700:Verapamil / Q000627:therapeutic use*
chemical_list: D000889:Anti-Arrhythmia Agents; D004077:Digoxin; D014700:Verapamil; D002118:Calcium