title: The Drug And Pace Health cliNical Evaluation (DAPHNE) study: a randomized trial comparing sotalol versus beta-blockers to treat symptomatic atrial fibrillation in patients with brady-tachycardia syndrome implanted with an antitachycardia pacemaker.
abstract: BACKGROUND
  Atrial tachyarrhythmias (ATAs) are mainly treated by pharmacologic therapy for rate control or rhythm control. The aim of our study was to compare sotalol (S) versus beta-blocking agents (BB) in terms of prevention of ATA, cardioversions (CVs), and cardiovascular hospitalizations (H) in patients paced for bradycardia-tachycardia form of sinus node disease (BT-SND).
  
  
  METHODS
  One hundred thirty-five patients (67 males, aged 73 +/- 7 years) were enrolled in a prospective, parallel, randomized, single-blind, multicenter study. All patients received a dual chamber rate adaptive pacemaker; after 1 month, 66 patients were randomly assigned to BB (62 +/- 26 and 104 +/- 47 mg/d for atenolol and metoprolol, respectively) and 69 patients to S (167 +/- 66 mg/d).
  
  
  RESULTS
  After an observation period of 12 months, the percentage of patients free from ATA recurrences was 29% in both BB and S group. Cardioversion and H were significantly (P < .01) fewer in the 12 months after implantation than in the 12 months before both in patients treated with S (CV 69.4% vs 22.2%, H 91.7% vs 33.3%) and in patients treated with BB (CV 58.5% vs 17.1%, H 82.9% vs 26.8%). Kaplan-Meier survival analysis showed a nonsignificant trend toward a lower incidence of the composite end point (CV + H) among BB patients.
  
  
  CONCLUSIONS
  In the complex context of "hybrid therapy" in patients with BT-SND implanted with a modern dual chamber rate adaptive pacemaker device delivering atrial antitachycardia pacing, no differences were found between the use of beta-blocker and the use of S, at the relatively low dose achieved after clinical titration, in terms of prevention of cardiovascular H or need for atrial CV.
authors.affiliation: Cardiology Department, Civile Hospital, Piacenza, Italy. progettovita@hotmail.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.forename: Gianluca
authors.initials: G
authors.lastname: Botto
authors.forename: Giulio
authors.initials: G
authors.lastname: Molon
authors.forename: Andrea
authors.initials: A
authors.lastname: Spampinato
authors.forename: Stefano
authors.initials: S
authors.lastname: Favale
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
authors.forename: Antonio
authors.initials: A
authors.lastname: Porfilio
authors.forename: Tiziana
authors.initials: T
authors.lastname: Marotta
authors.forename: Marco
authors.initials: M
authors.lastname: Vimercati
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001919:Bradycardia / Q000150:complications / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D016037:Single-Blind Method; D013015:Sotalol / Q000009:adverse effects / Q000627:therapeutic use*; D013610:Tachycardia / Q000150:complications / Q000628:therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D013015:Sotalol