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New Guidelines for Atrial Fibrillation Therapy Challenged

Editorial says digoxin should not be replaced as mainstay of heart rate control

MONDAY, Nov. 26 (HealthDay News) -- New guidelines that replace digoxin as the mainstay treatment for control of heart rate in patients with chronic atrial fibrillation have been challenged in an editorial published in the Nov. 24 issue of BMJ.

Theodora Nikolaidou, research fellow, and Kevin S. Channer, M.D., of the Royal Hallamshire Hospital in Sheffield, England, object to new joint guidelines issued by the American College of Cardiology, the American Heart Association and the European Society of Cardiology. The authors reviewed 57 studies, including 25 randomized, double-blind controlled trials, which assessed digoxin, beta-blockers, calcium antagonists and combinations of these for heart rate control in chronic atrial fibrillation. Trial sizes ranged from six participants to 136.

The editorialists argue that little evidence exists that monotherapy with either beta-blockers or calcium channel blockers improves exercise tolerance compared with digoxin. They also believe there is little evidence that monotherapy with either of the two alternative medications improves heart control rate at rest and during exercise compared with digoxin alone.

"We believe that the combination of digoxin and a beta-blocker or calcium antagonist should be recommended as first line management," the authors conclude. "We emphasize that it is safest to start treatment with digoxin first."

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