title: Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation.
abstract: OBJECTIVE
  Rate control of atrial fibrillation (AF) has become a main treatment modality, but we need more knowledge regarding the different drugs used for this purpose. In this study, we aimed to compare the effect of four common rate-reducing drugs on exercise capacity and levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with permanent AF.
  
  
  RESULTS
  We included 60 patients (mean age 71 ± 9 years, 18 women) with permanent AF and normal left ventricular function in a randomized, cross-over, investigator-blind study. Diltiazem 360 mg, verapamil 240 mg, metoprolol 100 mg, and carvedilol 25 mg were administered o.d. for 3 weeks. At baseline and on the last day of each treatment period, the patients underwent a maximal cardiopulmonary exercise test and blood samples were obtained at rest and at peak exercise. The exercise capacity (peak VO2) was significantly lower during treatment with metoprolol and carvedilol compared with baseline (no treatment) or treatment with diltiazem and verapamil (P < 0.001 for all). Compared with baseline, treatment with diltiazem and verapamil significantly reduced the NT-proBNP levels both at rest and at peak exercise, whereas treatment with metoprolol and carvedilol increased the levels (P < 0.05 for all).
  
  
  CONCLUSIONS
  Rate-reducing treatment with diltiazem or verapamil preserved exercise capacity and reduced levels of NT-proBNP compared with baseline, whereas treatment with metoprolol or carvedilol reduced the exercise capacity and increased levels of NT-proBNP.
authors.affiliation: Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, PO. Box 83, Sogneprest Munthe Kaas' vei 100, N-1309 Rud, Norway.
authors.forename: Sara R
authors.initials: SR
authors.lastname: Ulimoen
authors.forename: Steve
authors.initials: S
authors.lastname: Enger
authors.forename: Are Hugo
authors.initials: AH
authors.lastname: Pripp
authors.forename: Michael
authors.initials: M
authors.lastname: Abdelnoor
authors.forename: Harald
authors.initials: H
authors.lastname: Arnesen
authors.forename: Knut
authors.initials: K
authors.lastname: Gjesdal
authors.forename: Arnljot
authors.initials: A
authors.lastname: Tveit
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D002227:Carbazoles / Q000008:administration & dosage; D000077261:Carvedilol; D018592:Cross-Over Studies; D003692:Delayed-Action Preparations; D004110:Diltiazem / Q000008:administration & dosage; D017079:Exercise Tolerance / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage; D020097:Natriuretic Peptide, Brain / Q000187:drug effects / Q000378:metabolism*; D010101:Oxygen Consumption / Q000187:drug effects; D010446:Peptide Fragments / Q000187:drug effects / Q000378:metabolism*; D011412:Propanolamines / Q000008:administration & dosage; D011446:Prospective Studies; D014700:Verapamil / Q000008:administration & dosage
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D002227:Carbazoles; D003692:Delayed-Action Preparations; D010446:Peptide Fragments; D011412:Propanolamines; C109794:pro-brain natriuretic peptide (1-76); D000077261:Carvedilol; D020097:Natriuretic Peptide, Brain; D014700:Verapamil; D004110:Diltiazem; D008790:Metoprolol
keywords: Atrial fibrillation; Exercise capacity; Natriuretic peptides; Rate control