Which is the best drug for “ventricular rate control” in atrial fibrillation ?
- Digoxin alone
- Diltiazem alone
- Atenolol alone
- Digoxin +Atenolol
- Digoxin + Diltiazem
The answer is 4.
This is based on a study done by Bramh N Singh and his team from California published in 1999 . (http://content.onlinejacc.org/cgi/reprint/33/2/304.pdf )It was a wonderful study involving just 12 patients , still good enough to prove a point . It was a sequential cross over study a rare theme in medical trials ! where same patients act as control .Hence bias and host variations are nil. Few excerpts from the study .
Few thoughts about this study
This study has clearly documented superiority of combined drug regimen for rate control in AF .
Still it leaves a lingering question ! Why verapamil was not used as an agent in this study ?
If only , verapamil was used (As we do in our hospital ) Digoxin -Atenolol combination would have faced a really tough competiton.
Another curiosity is , what would have been the power of a unique combination of Atenolol and Diltiazem in controlling ventricular rate in AF ?
Any way , it was a wonderful cross over study . Such studies are a rare breed , always welcome in this world of funny pharma trials wherein a new drug is compared with a dud drug called placebo !
Now . . . Try this one
- Corrects rhythm
- Controls ventricular rate
- Does both ?
How can it correct the rhythm alone ? If rhythm is corrected , rate will automatically be controlled unless Amiodarone converts AF into Sinus tachyardia !
Of course Amidarone fais to convert to sinus rhthm in many , still it may control the rate by its beta blocking action.