Rate control drugs differ in the prevention of progression of atrial fibrillation

T. Koldenhof*, P.E.P.J. Wijtvliet, N.A.H.A. Pluymaekers, M. Rienstra, R.J. Folkeringa, P. Bronzwaer, A. Elvan, J. Elders, R. Tukkie, J.G.L.M. Luermans, S.M.J. van Kuijk, J.G.P. Tijssen, I.C. van Gelder, H.J.G.M. Crijns, R.G. Tieleman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Aims We hypothesize that in patients with paroxysmal atrial fibrillation (AF), verapamil is associated with lower AF progression compared to beta blockers or no rate control. Methods and results In this pre-specified post hoc analysis of the RACE 4 randomized trial, the effect of rate control medication on AF progression in paroxysmal AF was analysed. Patients using Vaughan-Williams Class I or III antiarrhythmic drugs were excluded. The primary outcome was a composite of first electrical cardioversion (ECV), chemical cardioversion (CCV), or atrial ablation. Event rates are displayed using Kaplan-Meier curves and multivariable Cox regression analyses are used to adjust for baseline differences. Out of 666 patients with paroxysmal AF, 47 used verapamil, 383 used beta blockers, and 236 did not use rate control drugs. The verapamil group was significantly younger than the beta blocker group and contained more men than the no rate control group. Over a mean follow-up of 37 months, the primary outcome occurred in 17% in the verapamil group, 33% in the beta blocker group, and 33% in the no rate control group (P = 0.038). After adjusting for baseline characteristics, patients using verapamil have a significantly lower chance of receiving ECV, CCV, or atrial ablation compared to patients using beta blockers [hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.19-0.83] and no rate control (HR 0.64, 95% CI 0.44-0.93). Conclusion In patients with newly diagnosed paroxysmal AF, verapamil was associated with less AF progression, as compared to beta blockers and no rate control.
Original languageEnglish
Pages (from-to)384-389
Number of pages6
JournalEP Europace
Issue number3
Early online date20 Aug 2021
Publication statusPublished - 2 Mar 2022


  • Atrial fibrillation
  • Atrial fibrillation progression
  • Rate control
  • Rhythm control
  • RACE 4 study
  • RISK

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