, Volume 31, Issue 3, pp 185–197 | Cite as

Digitalis and Verapamil in Atrial Fibrillation and Flutter

Is Verapamil Now the Preferred Agent?
  • Herman O. Klein
  • Elieser Kaplinsky
Leading Article


Atrial Fibrillation Digoxin Verapamil Atrial Flutter Ventricular Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Aronow WS, Landa D, Plasencia G, Wong R, Karlsberg RP, et al. Verapamil in atrial fibrillation and atrial flutter. Clinical Pharmacology and Therapeutics 26: 578–583, 1979PubMedGoogle Scholar
  2. Baer FW, Farré J, Ross D, Vanagt EJ, Gorgels AP, et al. Electrophysiological effects of lorcainide, a new antiarrhythmic drug. British Heart Journal 45: 292–298, 1981CrossRefGoogle Scholar
  3. Belic N, Kramer N, Alisaug A, Singer DH. Digoxin: how effective for heart rate control in ambulatory patients with atrial fibrillation? Circulation 46 (Suppl. 2): II–114, 1972Google Scholar
  4. Bellet S. Clinical disorders of the heart beat, pp. 198–199, Lea & Febiger, Philadelphia, 1971Google Scholar
  5. Bellet S. Treatment of atrial arrhythmias. In Dreyfus & Likoff (Eds) Cardiac arrhythmias, pp. 171–179, Grune & Stratton, New York, 1973Google Scholar
  6. Belz GG, Doering W, Munkes R, Matthews J. Interaction between digoxin and calcium antagonists and antiarrhythmic agents. Clinical Pharmacology and Therapeutaics 33: 410–417, 1983CrossRefGoogle Scholar
  7. Bender F. Isoptin zur Behandlung der tachykarden Form des Vorhofflatterns. Medizinische Klinik 62: 634–636, 1967PubMedGoogle Scholar
  8. Bender F, Kojima N, Reploh HD, Oelmann G. Behandlung tachykarder Rhythmusstörungen des Herzens durch Beta-Rezeptorenblokade des Atrioventriculargewebes. Medizinische Welt 17: 1120–1123, 1966Google Scholar
  9. Bigger JT. Management of arrhythmias. In Braunwald(Ed). Heart disease. A textbook of cardiovascular medicine, pp. 691–743, W.B. Saunders, Philadelphia, 1980Google Scholar
  10. Blumgart H. The reaction to exercise of the heart affected by auricular fibrillation. Heart 11: 49–56, 1924Google Scholar
  11. Boothby CB, Garrard CS, Pickering D. Verapamil in cardiac arrhythmias. British Medical Journal 2: 660–661, 1972CrossRefGoogle Scholar
  12. Brichard G, Zimmerman PE. Verapamil in cardiac dysrhythmias during anaesthesia. British Journal of anaesthesia 42: 1005–1011, 1970PubMedCrossRefGoogle Scholar
  13. Brown RW, Goble AJ. Effect of propranolol on exercise tolerance of patients with atrial fibrillation. British Medical Journal 2: 279–280, 1969PubMedCrossRefGoogle Scholar
  14. Chamberlain DA, White RJ, Howard MR, Smith TW. Plasma digoxin concentrations in patients with atrial fibrillation. British Medical Journal 3: 429–432, 1970PubMedCrossRefGoogle Scholar
  15. Carleton RA, Miller PH, Graettinger JS. Effects of ouabain, atropine, and ouabain and atropine on A-V nodal conduction in man. Circulation Research 20: 283–288, 1967PubMedCrossRefGoogle Scholar
  16. Chung EK. Tachyarrhythmias. In Chung (Ed).Cardiac emergency care, pp. 101–155, Lea & Febiger, Philadelphia, 1980Google Scholar
  17. Cowan C, Gardiner P, Campbell RWF, Reid DS. Amiodarone versus digoxin in the treatment of atrial fibrillation complicating suspected acute myocardial infarction. Circulation (Suppl. 2): II-1746, 1984Google Scholar
  18. Curry PVL, Shenasa M. Atrial arrhythmias: clinical concepts. In Mandel (Ed.) Cardiac arrhythmias: their mechanisms, diagnosis, and management, pp. 167–192, 1980Google Scholar
  19. David D, DiSegni E, Klein HO, Kaplinsky E. Inefficacy of digitalis in the control of heart rate in patients with chronic atrial fibrillation: beneficial effect of an added beta-adrenergic blocking agent. American Journal of Cardiology 44: 1378–1381, 1979PubMedCrossRefGoogle Scholar
  20. Dominic J, McAllister Jr RG, Kuo CS, Pratap-Reddy C, Surawicz B. Verapamil plasma levels and ventricular rate response inpatients with atrial fibrillation and flutter. Clinical Pharmacology and Therapeutics 26: 710714, 1979Google Scholar
  21. Follath F, Fromer M, Meier P, Vozeh S. Pharmacodynamic comparison of oral and intravenous verapamil in atrial fibrillation. Clinical and Investigational Medicine 3: 49–51, 1980Google Scholar
  22. Gillis RA, Pearle DL, Levitt B. Digitalis: a neuroexcitatory drug. Circulation 52: 739–742, 1975PubMedCrossRefGoogle Scholar
  23. Gold H, Kwit NT, Otto, H, Fox T. Physiological adaptations in cardiac slowing by digitalis and their bearing on problems of digitalization in patients with auricular fibrillation. Journal of Pharmacology and Experimental Therapeutics 67: 224–238, 1939Google Scholar
  24. Goldman S, Probst P, Selzer A, Cohen K. Inefficacy of ‘therapeutic’ serum levels of digoxin in controlling the ventricular rate in atrial fibrillation. American Journal of Cardiology 35: 651–655, 1975PubMedCrossRefGoogle Scholar
  25. Gonzalez R, Scheinman MM. Treatment of supraventricular arrhythmias with intravenous and oral verapamil. Chest 80: 465–470, 1981PubMedCrossRefGoogle Scholar
  26. Goodman DJ, Rossen RM, Cannom, DS, Rider AK, Harrison DC. Effect of digoxin on atrioventricular conduction studies in patients with and without cardiac autonomic innervation. Circulation 51: 251–256, 1975PubMedCrossRefGoogle Scholar
  27. Gotsman MS, Lewis BS, Bakst A, Mitka AS. Verapamil in life-threatening tachyarrhythmias. South African Medical Journal 46: 2017–2019, 1972PubMedGoogle Scholar
  28. Gulamhusein S, Ko P, Carruthers G, Klein GJ. Acceleration of ventricular response during atrial fibrillation in the Wolff-Parkinson-White syndrome. Circulation 65: 348–354, 1982PubMedCrossRefGoogle Scholar
  29. Gulamhusein S, Ko P, Klein GJ. Ventricular fibrillation following verapamil in the Wolff-Parkinson-White syndrome. American Heart Journal 106: 145–147, 1983PubMedCrossRefGoogle Scholar
  30. Hagemeijer F. Verapamil in the management of supraventricular tachyarrhythmias occurring after a recent myocardial infarction. Circulation 57: 751–755, 1978PubMedCrossRefGoogle Scholar
  31. Harper RW, Whitford E, Middlebrook K, Federman J, Anderson S, et al. Effects of verapamil on the electrophysiologic properties of the accessory pathway in patients with the Wolff-Parkinson-White syndrome. American Journal of Cardiology 50: 1323–1330, 1982PubMedCrossRefGoogle Scholar
  32. Heng MK, Singh BN, Roche AHG, Norris RM, Mercer CJ. Effects of intravenous verapamil on cardiac arrhythmias and on the electrocardiogram. American Heart Journal 90: 487–498, 1975PubMedCrossRefGoogle Scholar
  33. Hoffman BF, Bigger JT. Digitalis and allied cardiac glycosides. In Goodman & Gilman (Eds) The pharmacological basis of therapeutics, pp. 729–760 Macmillan, New York, 1980Google Scholar
  34. Horio Y, Matsuyama, K, Morikami, Y, Rokutanda M, Hirata A, et al. Blocking effect on verapamil on conduction over a catecholamine-sensitive bypass tract in exercise-induced Wolff-Parkinson-White syndrome. Journal of the American College of Cardiology 4: 186–191, 1984PubMedCrossRefGoogle Scholar
  35. Horowitz LN, Spielman SR, Greenspan AM, Morganroth J, Brady MB, et al. Amiodarone therapy for resistant atrial fibrillation. (Abstract.) Journal of the American College of Cardiology 5: 480, 1985Google Scholar
  36. Kawai C, Konishi T, Matsuyama E, Okazaki H. Comparative effects of the three calcium antagonists, diltiazem, verapamil and nifedipine, on the sinoatrial and atrioventricular nodes. Experimental and clinical studies. Circulation 63: 1035–1042, 1981PubMedCrossRefGoogle Scholar
  37. Keefe DL, Harapat SR, Kates RE. Relationship between pharmacodynamics and myocardial concentration of verapamil. (Abstract.) American Journal of Cardiology 47: 406, 1981CrossRefGoogle Scholar
  38. Kerber RE, Goldman RH, Gianelly RE, Harrison, DC. Treatment of atrial arrhythmias with alprenolol. Journal of the American Medical Association 214: 1849–1854, 1970PubMedCrossRefGoogle Scholar
  39. Kerin N, Benederet D, Blevins R, Garfinkel C, Rubenfire M. Amiodarone in refractory atrial fibrillation. Circulation (Suppl. 2): 11–1754, 1984Google Scholar
  40. Khalsa A, Olsson SB. Verapamil-induced ventricular regularity in atrial fibrillation. Acta Medica Scandinavica 205: 509–515, 1979PubMedCrossRefGoogle Scholar
  41. Klein HO, DiSegni E, Kaplinsky, E. Paradoxic acceleration of ventricular rate after therapy with lidocaine and ajmaline. Chest 71:531–533, 1977PubMedCrossRefGoogle Scholar
  42. Klein HO, Pauzner H, DiSegni E, David D, Kaplinsky E. The beneficial effects of verapamil in chronic atrial fibrillation. Archives of Internal Medicine 139: 747–749, 1979PubMedCrossRefGoogle Scholar
  43. Klein HO, Lang R, DiSegni E, Sareli, P, David D, et al. Verapamil — superior to digoxin in the management of chronic atrial fibrillation? Circulation (Suppl.3): 111–84, 1980aGoogle Scholar
  44. Klein HO, Lang R, DiSegni E, Kaplinsky E. Verapamil-digoxin interaction. New England Journal of Medicine 303: 106, 1980bGoogle Scholar
  45. Klein HO, Kapainsky E. Verapamil and digoxin: their respective effects on atrial fibrillation and their interaction. American Journal of Cardiology 50: 894–902, 1982PubMedCrossRefGoogle Scholar
  46. Klein HO, Lang R, Weiss E, DiSegni E, Libhaber E. et al. The influence of verapamil on serum digoxin concentration. Circulation 65: 998–1003, 1982PubMedCrossRefGoogle Scholar
  47. Klein HO, Ninio R, Oren V, Lang R, Sereli P, et al. The acute hemodynamic effects of intravenous verapamil in coronary artery disease: assessment by equilibrium-gated radionuclide ventriculography. Circulation 67: 101–110, 1983PubMedCrossRefGoogle Scholar
  48. Knox JAC. The heart rate with exercise in patients with auricular fibrillation. British Heart Journal 11: 119–125, 1949PubMedCrossRefGoogle Scholar
  49. Koren G, Soldin S, MacLeod SM. Digoxin-verapamil interaction: in vitro studies in rat tissue. Journal of Cardiovascular Pharmacology 5: 443–445, 1983PubMedCrossRefGoogle Scholar
  50. Kosovsky BD, Haft JI, Lan SH, Stein E, Damato AN. The effects of digitalis on atrioventricular conduction in man. American Heart Journal 75: 736–742, 1968CrossRefGoogle Scholar
  51. Krikler DM, Spurrell RAJ. Verapamil in the treatment of paroxysmal supraventricular tachycardia. Postgraduate Medical Journal 50: 447–453, 1974PubMedCrossRefGoogle Scholar
  52. Lang R, Klein HO, Weiss E, David D, Sareli P, et al. Superiority of oral verapamil therapy to digoxin in treatment of chronic atrial fibrillation. Chest 83: 491–499, 1983aPubMedCrossRefGoogle Scholar
  53. Lang R, Klein HO, DiSegni E, Gefen J, Sareli P, et al. Verapamil improves exercise capacity in chronic atrial fibrillation: double blind crossover study. American Heart Journal 105: 820–825, 1983bPubMedCrossRefGoogle Scholar
  54. Lemberg L, Castellanos Jr A, Acerbal AG. The use of propranolol in arrhythmias complicating acute myocardial infarction. American Heart Journal 80: 479–483, 1970PubMedCrossRefGoogle Scholar
  55. Lewis T. Diseases of the heart, p. 90, MacMillan, New York, 1934.Google Scholar
  56. Luten D, Jeffreys EO. The clinical significance of auricular fibrillation. Journal of the American Medical Association 107: 2099–2102,1936CrossRefGoogle Scholar
  57. Mackenzie J. Digitalis. Heart 2: 273–386, 1911Google Scholar
  58. Naito M, Mitani I, Ijiri M, Furuno I, Miyairi M, et al. Beneficial effect of intravenous diltiazem on supraventricular tachyarrhythmias. (Abstract). Journal of the American College of Cardiology 5: 481, 1985Google Scholar
  59. Opie LH. Drugs and the heart. III: Calcium antagonists. Lancet 1: 806–810, 1980PubMedCrossRefGoogle Scholar
  60. Pedersen KE, Dorph-Pedersen A, Hvidt S, Kitgaard NA, Nielsen-Kudsk F. Digoxin-verapamil interaction. Clinical Pharmacology and Therapeutics 30: 311–317, 1981PubMedCrossRefGoogle Scholar
  61. Pederson KE, Christiansen BD, Kjaer K, Klitgaard NA, Nielsen-Kudsk F. Verapamil-induced changes in dogoxin kinetics and intraerythrocytic sodium concentration. Clinical Pharmacology and Therapeutics 34: 8–13, 1983CrossRefGoogle Scholar
  62. Petri H, Kafka W, Hall D, Rudolph W. Potential acceleration of the ventricular rate in WPW with atrial fibrillation after verapamil. Circulation 62 (Suppl.3): III–262, 1980Google Scholar
  63. Petri H, Kafka W, Hansen W, Rudolph W. Discrepant effect of intravenous and oral verapamil on the ventricular rate in WPW syndrome during atrial fibrillation. Circulation (Suppl. 2): II-1082, 1982Google Scholar
  64. Plumb VJ, Karp RB, Kouchoukos NT, Zorn Jr GL, James TN, et al. Verapamil treatment of atrial fibrillation and atrial flutter after open heart surgery. Circulation (Suppl. 3): III-308, 1980Google Scholar
  65. Probst P. The influence of propafenon on the accessory pathway in WPW-syndrome (an acute intravenous study). Circulation (Suppl. 2): 11–1757, 1984Google Scholar
  66. Redfors A. The effect of different digoxin doses on subjective symptoms and physical working capacity in patients with atrial fibrillation. Acta Medica Scandinavica 190: 307–320, 1971aPubMedCrossRefGoogle Scholar
  67. Redfors, A. Digoxin dosage and ventricular rate at rest and exercise in patients with atrial fibrillation. Acta Medica Scandinavica 190: 321–333, 1971bPubMedCrossRefGoogle Scholar
  68. Redfors A. Plasma digoxin concentration — its relationship to digoxin dosage and clinical effects in patients with atrial fibrillation. British Heart Journal 34: 383–391, 1972PubMedCrossRefGoogle Scholar
  69. Ricci DR, Orlick AE, Reitz BA, Mason JW, Stinson EB, et al. Depressant effect of digoxin on atrioventricular conduction in man. Circulation 57: 898–903, 1978PubMedCrossRefGoogle Scholar
  70. Rinkenberger RL, Prystowsky EN, Hegger JJ, Troup PJ, Jackman WM, et al. Effects of intravenous and chronic oral verapamil administration in patients with supraventricular tachyarrhythmias. Circulation 62: 996–1010, 1980PubMedCrossRefGoogle Scholar
  71. Rosen MR, Wit ALA Hoffman BF. Electrophysiology and pharmacology of cardiac arrhythmias. IV. Cardiac antiarrhythmic and toxic effect of digitalis. American Heart Journal 89: 391–399, 1975aPubMedCrossRefGoogle Scholar
  72. Rosen MR, Wit AL, Hoffman BF. Electophysiology and pharmacology of cardiac arrhythmias. VI. Cardiac effects of verapamil. American Heart Journal 89: 665–673, 1975bPubMedCrossRefGoogle Scholar
  73. Rosen KM, Lau SH, Weiss MB. The effect of lidocaine on atrioventricular and intraventricular conduction in man. American Journal of Cardiology 25: 1–5, 1970PubMedCrossRefGoogle Scholar
  74. Rowland RW. Augmented ventricular rate following verapamil treatment for atrial fibrillation with Wolff-Parkinson-White syndrome. Pediatrics 72: 245–246, 1983PubMedGoogle Scholar
  75. Rowland E, McKenna WJ, Harris L, Holt DW, Krikler DM. Amiodarone in the prophylaxis of atrial fibrillation. In Kulbertus et al. (Eds) Atrial fibrillation, pp. 262–271, A.B. Hässle, Mölndal, Sweden, 1982Google Scholar
  76. Rowland E, McKenna W, Holt D, Perelman M, Krikler D. Oral amiodarone for the conversion of established atrial fibrillation. Circulation (Suppl. 2): II-1755, 1984Google Scholar
  77. Sacks H, Kennelly BM. Verapamil in cardiac arrhythmias. British Medical Journal 2: 716, 1972PubMedCrossRefGoogle Scholar
  78. Schamroth L. Immediate effects of intravenous verapamil on atrial fibrillation. Cardiovascular Research 5: 419–424, 1971PubMedCrossRefGoogle Scholar
  79. Schamroth L. The clinical use of intravenous verapamil. American Heart Journal 100: 1070–1075, 1980PubMedCrossRefGoogle Scholar
  80. Schwartz JB, Keefe D, Kates RE, Kirsten E, Harrison DC. Acute and chronic pharmacodynamic interaction of verapamil and digoxin in atrial fibrillation. Circulation 65: 1163–1170 1982.PubMedCrossRefGoogle Scholar
  81. Selzer A. Hemodynamic effects of digitalis. In Dreifus et al. (Eds) Mechanisms and therapy of cardiac arrhythmias, pp. 562–565, Grune and Stratton, New York, 1966Google Scholar
  82. Singh BN, Ellrodt G, Peter CT. Verapamil: a review of its pharmacological properties and therapeutic use. Drugs 15: 169–197, 1978PubMedCrossRefGoogle Scholar
  83. Sobel BE, Braunwald E. Cardiac dysrhythmias. In Isselbacher et al. (Eds) Harrison’s principles of internal medicine, pp. 1056, McGraw-Hill, New York, 1980Google Scholar
  84. Spann JF, Hurst JW. The recognition and management of heart failure. In Hurst (Ed.) The heart, arteries and veins, pp. 407–451, McGraw Hill, New York, 1982Google Scholar
  85. Spurrell RAJ, Krikler DM, Sowton E. Effects of verapamil on electrophysiological properties of anomalous atrioventricular connection in Wolff-Parkinson-White syndrome. British Heart Journal 36: 256–264, 1974aPubMedCrossRefGoogle Scholar
  86. Spurrell RAJ, Krikler DM, Sowton E. Concealed bypasses of the atrioventricular node in patients with paroxysmal supraventricular tachycardia revealed by intracardiac electrical stimulation and verapamil. American Journal of Cardiology 38: 590–595, 1974bCrossRefGoogle Scholar
  87. Stern EH, Pitchon R, King BD, Guerrero J, Schneider RR et al. Clinical use of oral verapamil in chronic and paroxysmal atrial fibrillation. Chest 81: 308–311, 1982PubMedCrossRefGoogle Scholar
  88. Stone PH, Antman EM, Muller JE, Braunwald E. Calcium channel blocking agents in the treatment of cardiovascular disorders. Part II: hemodynamic effects and clinical applications. Annals of Internal Medicine 93: 886–904, 1980PubMedGoogle Scholar
  89. Sung RJ, Waxman HL, Elser B, Juma Z. Treatment of paroxysmal supraventricular tachycardia and atrial flutter-fibrillation with intravenous verapamil: efficacy and mechanism of action. Clinical and Investigational Medicine 3: 41–47, 1980aGoogle Scholar
  90. Sung RJ, Elser B, McAllister RG. Intravenous verapamil for termination of re-entrant supraventricular tachycardias. Annals of Internal Medicine 93: 682–689 1980bPubMedGoogle Scholar
  91. Tai DY, Chang M, Svinarich JT, Chiang BN, Sung RJ. Mechanisms of verapamil-induced conduction block in anomalous atrioventricular bypass tracts. Journal of the American College of Cardiology 5: 311–317, 1985PubMedCrossRefGoogle Scholar
  92. Theisen K, Haufe M, Peters J, Theisen F, Jahrmärker H. Effect of the calcium antagonist diltiazem on atrioventricular conduction in chronic atrial fibrillation. American Journal of Cardiology 55: 98–102, 1985PubMedCrossRefGoogle Scholar
  93. Tommaso C, McDonough T, Parker M, Talano JV. Atrial fibrillation and flutter: immediate control and conversion with intravenously administered verapamil. Archives of Internal Medicine 143: 877–881, 1983PubMedCrossRefGoogle Scholar
  94. Vohra J, Hunt D, Sloman G. Clinical experience with verapamil. Medical Journal of Australia 2: 417–421, 1975PubMedGoogle Scholar
  95. Waxman HL, Myerburg RJ, Apel R, Sung RJ. Verapamil for control of ventricular rate in paroxysmal supraventricular tachycardia and atrial fibrillation or flutter. A double-blind randomized cross-over study. Annals of Internal Medicine 94: 1–6, 1981PubMedGoogle Scholar
  96. Weiner R, Bassan MM, Jarchovsky J, Iusim S, Plavnick L. Clinical course of acute atrial fibrillation treated with rapid digitalization. American Heart Journal 105: 223–227, 1983PubMedCrossRefGoogle Scholar
  97. Weinstein W, Plaut J, Katz LN. Limitations of the use of digitalis for ambulatory patients with auricular fibrillation. American Journal of Medicine 199: 498–505, 1940Google Scholar
  98. Weiss AT, Lewis BS, Halon DA, Hasin Y, Gotsman MS. The use of calcium with verapamil in the management of supraventricular tachyarrhythmias. International Journal of Cardiology 4: 275–280, 1983PubMedCrossRefGoogle Scholar
  99. Wellens HJJ, Tau SL, Bär FWH, Duren DR, Lie KI et al. Effect of verapamil studied by programmed electrical stimulation of the heart in patients with paroxysmal re-entrant supraventricular tachycardia. British Heart Journal 39: 1058–1066, 1977PubMedCrossRefGoogle Scholar
  100. Wit AL, Cranefield PF. The effects of verapamil on the sinoatrial and atrioventricular nodes of the rabbit and the mechanism by which it arrests reentrant A-V nodal tachycardia. Circulation Research 35: 413–425, 1974PubMedCrossRefGoogle Scholar
  101. Wolfson S, Herman MV, Sullivan JM, Gorlin R. Conversion of atrial fibrillation and flutter by propranolol. British Heart Journal 29: 305–309, 1967PubMedCrossRefGoogle Scholar
  102. Zipes DP. Management of cardiac arrhythmias. In Braunwald (Ed). Heart disease, pp. 648–682, W.B. Saunders, Philadelphia, 1984Google Scholar
  103. Zipes DP, Fischer JC. Effects of agents which inhibit the slow channel on sinus node automaticity and atrioventricular conduction in the dog. Circulation Research 34: 184–192, 1974PubMedCrossRefGoogle Scholar

Copyright information

© ADIS Press Limited 1986

Authors and Affiliations

  • Herman O. Klein
    • 1
    • 2
  • Elieser Kaplinsky
    • 1
    • 2
  1. 1.Department of CardiologyMeir ‘General Hospital’Kfar SabaIsrael
  2. 2.Sackler School of MedicineTel Aviv UniversityTel Aviv

Personalised recommendations