In the treatment of heart failure a...

In the treatment of heart failure and atrial fibrillation, digoxin has been a longstanding option. It is standard therapy in patients with heart failure and atrial fibrillation, yet it is inadequate at rate restrain in these patients during exercise or times of increased sympathetic tone. Multiple studies have shown the benefit of beta-blocker therapy in the treatment of patients with heart failure. In addition, beta blocker have been shown to improve ventricular rate rule in atrial fibrillation alone or in combination with digoxin. Despite these studies, no information demonstrates that beta blocker alone or in combination with digoxin improve results in patients with heart failure and persistent atrial fibrillation. Khand and associates evaluated the use of digoxin, carvedilol, and their combination in the treatment of patients with heart failure and persistent atrial fibrillation.

The trial was a randomized, double-blind, placebo-controlled reflection of patients who met the standard criteria for heart failure and persistent atrial fibrillation for more then single in kind month. All patients who set downed the trial were taking digoxin. In phase 1 of the thought digoxin alone was compared with the combination of carvedilol and digoxin for four month In phase 2 digoxin was withdrawn in a double-blinded fashion. Patients were assessed at the start of the consideration and at the end of each phase. Primary consequence measurements included assessment of left ventricular function, ventricular rate direction symptoms, and exercise tolerance.

There were 47 patients who participated in the studious mood The combination of digoxin and carvedilol, when compared with digoxin alone, provided a significantly lower ventricular rate onward 24-hour monitoring and during submaximal exercise. In addition, combination therapy provided significantly better symptom restrain and improved left ventricular function compared with digoxin alone. When patients were changed to carvedilol alone, their mean ventricular rate rose and the left ventricular ejection fraction declined. There was no difference in the six-minute walk distance between treatment arms.

The authors judge that the combination of digoxin and carvedilol in the treatment of patients with heart failure and persistent atrial fibrillation is superior to either medication alone. They add that the combination provides better left ventricular function and ventricular rate command In patients who were taking the combination, left ventricular function and rate reign over deteriorated after digoxin withdrawal. This cogitation is the first to demonstrate the added benefit of digoxin in patients who are receiving beta-blocker therapy.

KARL E MILLER, MD

Khand AU, et al. Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure? J Am Coll Cardiol December 3 2003;42:1944-51

COPYRIGHT 2004 American Academy of Family Physicians

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