J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 5, Number 6, December 2013, pages 451-459

Effect of Carvedilol on Reduction in Heart Rate in Patients With Chronic Atrial Fibrillation

**Table 1.** Characteristics of Patients
		Groups of final daily carvedilol doses
* Heart rate-lowering drugs.
Number of patients, n	13	4	3	6
Male gender, n (%)	7 (53.8)	3	0	4
Age, year (range)	73.2 ± 11.8 (41 - 86)	74.3 ± 10.8 (60 - 86)	80.7 ± 4.0 (76 - 83)	38.8 ± 14.2 (41 - 80)
Body height, cm	161.6 ± 12.9	168.0 ± 10.2	147.8 ± 5.4	164.1 ± 13.1
Body weight, kg	62.4 ± 18.1	57.4 ± 8.1	52.0 ± 2.2	70.9 ± 24.0
Body mass index, kg/m²	23.6 ± 4.7	20.4 ± 2.6	23.9 ± 2.2	25.7 ± 5.8
Duration of atrial fibrillation, year	7.4 ± 6.3	10.3 ± 9.2	2.8 ± 3.7	7.8 ± 3.8
Types of atrial fibrillation
Persistent, n (%)	11 (84.6)	4	3	4
Permanent, n (%)	2 (15.4)	0	0	2
Underlying diseases
Diabetes mellitus, n (%)	4 (30.8)	2	1	1
Dyslipidemia, n (%)	6 (46.2)	1	2	3
Prior myocardial infarction, n (%)	1 (7.7)	1	0	0
Coadministration
Digitalis*, n (%)	6 (46.2)	2	1	3
Verapamil*, n (%)	2 (15.4)	0	0	2
Bepridil*, n (%)	1 (7.7)	0	0	1
Pilsicainide, n (%)	1 (7.7)	0	0	1
Warfarin, n (%)	11 (84.6)	3	3	5

Table 1. Characteristics of Patients

Groups of final daily carvedilol doses

Overall

5 mg

10 mg

20 mg

* Heart rate-lowering drugs.

Number of patients, n

Male gender, n (%)

7 (53.8)

Age, year
(range)

73.2 ± 11.8
(41 - 86)

74.3 ± 10.8
(60 - 86)

80.7 ± 4.0
(76 - 83)

38.8 ± 14.2
(41 - 80)

Body height, cm

161.6 ± 12.9

168.0 ± 10.2

147.8 ± 5.4

164.1 ± 13.1

Body weight, kg

62.4 ± 18.1

57.4 ± 8.1

52.0 ± 2.2

70.9 ± 24.0

Body mass index, kg/m²

23.6 ± 4.7

20.4 ± 2.6

23.9 ± 2.2

25.7 ± 5.8

Duration of atrial fibrillation, year

7.4 ± 6.3

10.3 ± 9.2

2.8 ± 3.7

7.8 ± 3.8

Types of atrial fibrillation

Persistent, n (%)

11 (84.6)

Permanent, n (%)

2 (15.4)

Underlying diseases

Diabetes mellitus, n (%)

4 (30.8)

Dyslipidemia, n (%)

6 (46.2)

Prior myocardial infarction, n (%)

1 (7.7)

Coadministration

Digitalis*, n (%)

6 (46.2)

Verapamil*, n (%)

2 (15.4)

Bepridil*, n (%)

1 (7.7)

Pilsicainide, n (%)

1 (7.7)

Warfarin, n (%)

11 (84.6)

**Table 2.** Changes in Heart Rate After Treatment With Carvedilol
	Baseline	4 - 8 weeks	8 - 12 weeks	12 - 16 weeks	%change in heart rate after 12 - 16 weeks
Data are means ± SD, bpm. ** P < 0.01, * P < 0.05 vs. Baseline, ^† P < 0.05 vs. Unused.
Overall (N = 13)	101.9 ± 13.9	82.5 ± 12.6**	85.2 ± 10.4**	85.2 ± 15.2*	-13.9 ± 16.7
Dose of carvedilol, mg	-	5.0 ± 0.0	9.1 ± 2.0	13.1 ± 6.9
Groups of final daily carvedilol doses
5 mg (N = 4)	106.2 ± 19.4	75.2 ± 14.5*	72.3 ± 0.4	85.7 ± 27.4	-19.0 ± 19.2
10 mg (N = 3)	105.1 ± 12.6	75.6 ± 8.2	83.1 ± 6.9	79.6 ± 20.8	-16.3 ± 25.6
20 mg (N = 6)	97.5 ± 11.4	90.8 ± 8.8	90.5 ± 9.6*	87.9 ± 10.5	-9.4 ± 11.7
Usage of heart rate-lowering drugs
Used (N = 7)	96.1 ± 7.4	85.6 ± 6.6*	82.5 ± 6.4*	91.3 ± 13.2	-4.4 ± 13.4^†
Unused (N = 6)	108.8 ± 7.1	78.9 ± 17.3*	88.4 ± 13.9*	77.9 ± 15.3*	-25.1 ± 13.3

Table 2. Changes in Heart Rate After Treatment With Carvedilol

Baseline

4 - 8 weeks

8 - 12 weeks

12 - 16 weeks

%change in heart rate after 12 - 16 weeks

Data are means ± SD, bpm. ** P < 0.01, * P < 0.05 vs. Baseline, ^† P < 0.05 vs. Unused.

Overall (N = 13)

101.9 ± 13.9

82.5 ± 12.6**

85.2 ± 10.4**

85.2 ± 15.2*

-13.9 ± 16.7

Dose of carvedilol, mg

5.0 ± 0.0

9.1 ± 2.0

13.1 ± 6.9

Groups of final daily carvedilol doses

5 mg (N = 4)

106.2 ± 19.4

75.2 ± 14.5*

72.3 ± 0.4

85.7 ± 27.4

-19.0 ± 19.2

10 mg (N = 3)

105.1 ± 12.6

75.6 ± 8.2

83.1 ± 6.9

79.6 ± 20.8

-16.3 ± 25.6

20 mg (N = 6)

97.5 ± 11.4

90.8 ± 8.8

90.5 ± 9.6*

87.9 ± 10.5

-9.4 ± 11.7

Usage of heart rate-lowering drugs

Used (N = 7)

96.1 ± 7.4

85.6 ± 6.6*

82.5 ± 6.4*

91.3 ± 13.2

-4.4 ± 13.4^†

Unused (N = 6)

108.8 ± 7.1

78.9 ± 17.3*

88.4 ± 13.9*

77.9 ± 15.3*

-25.1 ± 13.3

**Table 3.** Changes in Parameters of 24-Hour Holter Electrocardiogram Monitoring
	Baseline	12 - 16 weeks	%change in total heart beats
Data are means ± SD. * P < 0.001, P < 0.01, * P < 0.05 vs. Baseline.
Overall (N = 11)
Total heart beats, /day	128,411 ± 12,690	114,526 ± 11580***	-10.7 ± 4.5
Maximum heart rate, bpm	164 ± 8	134 ± 12***
Minimum heart rate, bpm	60 ± 9	56 ± 7
Mean heart rate, bpm	93 ± 12	82 ± 8***
Groups of final daily carvedilol doses
5 mg (N = 2)
Total heart beats, /day	131,382 ± 14,551	113,070 ± 5,218	-13.6 ± 5.6
Maximum heart rate, bpm	159 ± 11	144 ± 11
Minimum heart rate, bpm	58 ± 20	50 ± 2
Mean heart rate, bpm	97 ± 8	82 ± 4
10 mg (N = 3)
Total heart beats, /day	119,794 ± 15,193	104,539 ± 8,313*	-12.4 ± 4.4
Maximum heart rate, bpm	162 ± 12	121 ± 14*
Minimum heart rate, bpm	54 ± 11	51 ± 7
Mean heart rate, bpm	88 ± 9	75 ± 4*
20 mg (N = 6)
Total heart beats, /day	131,730 ± 11,229	120,005 ± 11,763**	-8.9 ± 4.1
Maximum heart rate, bpm	167 ± 7	137 ± 5***
Minimum heart rate, bpm	63 ± 5	60 ± 6
Mean heart rate, bpm	95 ± 8	85 ± 4**

Table 3. Changes in Parameters of 24-Hour Holter Electrocardiogram Monitoring

Baseline

12 - 16 weeks

%change in total heart beats

Data are means ± SD. *** P < 0.001, ** P < 0.01, * P < 0.05 vs. Baseline.

Overall (N = 11)

Total heart beats, /day

128,411 ± 12,690

114,526 ± 11580***

-10.7 ± 4.5

Maximum heart rate, bpm

164 ± 8

134 ± 12***

Minimum heart rate, bpm

60 ± 9

56 ± 7

Mean heart rate, bpm

93 ± 12

82 ± 8***

Groups of final daily carvedilol doses

5 mg (N = 2)

Total heart beats, /day

131,382 ± 14,551

113,070 ± 5,218

-13.6 ± 5.6

Maximum heart rate, bpm

159 ± 11

144 ± 11

Minimum heart rate, bpm

58 ± 20

50 ± 2

Mean heart rate, bpm

97 ± 8

82 ± 4

10 mg (N = 3)

Total heart beats, /day

119,794 ± 15,193

104,539 ± 8,313*

-12.4 ± 4.4

Maximum heart rate, bpm

162 ± 12

121 ± 14*

Minimum heart rate, bpm

54 ± 11

51 ± 7

Mean heart rate, bpm

88 ± 9

75 ± 4*

20 mg (N = 6)

Total heart beats, /day

131,730 ± 11,229

120,005 ± 11,763**

-8.9 ± 4.1

Maximum heart rate, bpm

167 ± 7

137 ± 5***

Minimum heart rate, bpm

63 ± 5

60 ± 6

Mean heart rate, bpm

95 ± 8

85 ± 4**

**Table 4.** Changes in AFQLQ Scores and Other Parameters
	Baseline	4 - 8 weeks	8 - 12 weeks	12 - 16 weeks
QTc: heart rate-corrected QT (= QT/RR0.5 by Bazett’s formula); AFQLQ: Atrial Fibrillation Quality of Life Questionnaire; LAD: left atrial dimension; LVDd: left ventricular end-diastolic dimension; LVDs: left ventricular end-systolic dimension; %FS: %change in fractioning shortening; LVEF: left ventricular ejection fraction (Teichholz); BNP: brain natriuretic peptide; hsCRP: high-sensitivity C-reactive protein. Data are means ± SD. ** P < 0.01, * P < 0.05 vs. Baseline.
AFQLQ (maximum points = 98)	84 ± 11	85 ± 7	81 ± 11	86 ± 9
AFQLQ1 (24)	18 ± 5	17 ± 5	17 ± 5	19 ± 5
AFQLQ2 (18)	15 ± 3	15 ± 2	15 ± 3	16 ± 2
AFQLQ3 (56)	51 ± 5	53 ± 3	50 ± 6	52 ± 5
Office blood pressure
Systolic blood pressure, mmHg	123.5 ± 9.4	121.0 ± 13.2	127.6 ± 6.6	124.0 ± 11.8
Diastolic blood pressure, mmHg	75.1 ± 8.2	73.8 ± 6.4	73.1 ± 7.4	74.9 ± 6.6
Electrocardiogram
Heat beats for 3 min, /3 min	306 ± 41	248 ± 38**	256 ± 31**	252 ± 42*
QT interval, msec	333 ± 24	368 ± 31**	359 ± 21**	367 ± 31*
QTc interval, msec	437 ± 20	437 ± 25	435 ± 26	440 ± 30
Width of QRS, msec	91 ± 8	91 ± 8	91 ± 9	93 ± 9
Echocardiogram
LAD, mm	41.1 ± 4.6	-	-	44.1 ± 4.9*
LVDd, mm	44.4 ± 4.4	-	-	46.8 ± 3.3
LVDs, mm	30.0 ± 3.1	-	-	32.2 ± 2.6*
%FS, %	32.4 ± 4.2	-	-	31.8 ± 4.9
LVEF, %	60.3 ± 6.2	-	-	58.9 ± 7.4
Blood Examinations
BNP, pg/mL	134 ± 101	-	-	166 ± 108
hs-CRP, mg/dL	0.100 ± 0.144	-	-	0.058 ± 0.038

Table 4. Changes in AFQLQ Scores and Other Parameters

Baseline

4 - 8 weeks

8 - 12 weeks

12 - 16 weeks

QTc: heart rate-corrected QT (= QT/RR0.5 by Bazett’s formula); AFQLQ: Atrial Fibrillation Quality of Life Questionnaire; LAD: left atrial dimension; LVDd: left ventricular end-diastolic dimension; LVDs: left ventricular end-systolic dimension; %FS: %change in fractioning shortening; LVEF: left ventricular ejection fraction (Teichholz); BNP: brain natriuretic peptide; hsCRP: high-sensitivity C-reactive protein. Data are means ± SD. ** P < 0.01, * P < 0.05 vs. Baseline.

AFQLQ (maximum points = 98)

84 ± 11

85 ± 7

81 ± 11

86 ± 9

AFQLQ1 (24)

18 ± 5

17 ± 5

19 ± 5

AFQLQ2 (18)

15 ± 3

15 ± 2

15 ± 3

16 ± 2

AFQLQ3 (56)

51 ± 5

53 ± 3

50 ± 6

52 ± 5

Office blood pressure

Systolic blood pressure, mmHg

123.5 ± 9.4

121.0 ± 13.2

127.6 ± 6.6

124.0 ± 11.8

Diastolic blood pressure, mmHg

75.1 ± 8.2

73.8 ± 6.4

73.1 ± 7.4

74.9 ± 6.6

Electrocardiogram

Heat beats for 3 min, /3 min

306 ± 41

248 ± 38**

256 ± 31**

252 ± 42*

QT interval, msec

333 ± 24

368 ± 31**

359 ± 21**

367 ± 31*

QTc interval, msec

437 ± 20

437 ± 25

435 ± 26

440 ± 30

Width of QRS, msec

91 ± 8

91 ± 9

93 ± 9

Echocardiogram

LAD, mm

41.1 ± 4.6

44.1 ± 4.9*

LVDd, mm

44.4 ± 4.4

46.8 ± 3.3

LVDs, mm

30.0 ± 3.1

32.2 ± 2.6*

%FS, %

32.4 ± 4.2

31.8 ± 4.9

LVEF, %

60.3 ± 6.2

58.9 ± 7.4

Blood Examinations

BNP, pg/mL

134 ± 101

166 ± 108

hs-CRP, mg/dL

0.100 ± 0.144

0.058 ± 0.038