Atrial fibrillation: verapamil slowed the ventricular rate.

Clinical bottom line (level 1b)

  1. Patients with atrial fibrillation or flutter poorly-controlled by digoxin who received verapamil iv compared with placebo were more likely to go into sinus rhythm (NNT = 3 at 10 minutes) .
  2. Patients had a lower ventricular rate (on average 37 beats/min less).
Tommaso et al: Archives of Internal Medicine 1983; 143: 877-881
Expires November 2004

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: university hospital, USA

17 patients (aged ?, ?% male) atrial fibrillation or flutter poorly controlled by digitalis with or without disopyramide, quinidine or lidocaine (resting heart rate >110 beats/min)

Excluded if
  • on beta-blockers within last 48 hours
  • sick sinus syndrome (unless a pacemaker in situ)
  • second degree or higher AV block
  • MI within last 3 months


    • Control Group: (n = 9, 9 analysed): placebo
    Experimental Group: (n = 8, 8 analysed): verapamil 0.075 mg/kg iv over 60 seconds (to a maximum of 5 mg)

    100% followed for 10 minutes

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no sinus rhythm 10 minutes 9
    (100%)    		 5
    (62.5%)    		 38%
    (-7% to 63%)    		 37.5%
    (3.95% to 71.1%)    		 3
    (1 to 25)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    ventricular rate at start 120
    (9)     		127
    (13)     		7
    (-4 to 18)
    ventricular rate at 10 minutes 123
    (9)     		86
    (14)     		-37
    (-49 to -25)

    Citation

    1. Tommaso C, McDonough T, Parker M, et al: Atrial fibrillation and flutter: immediate control and conversion with intravenously administered verapamil. Archives of Internal Medicine 1983; 143: 877-881
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer:

    Clinical Question.
    Patient AF
    Intervention or Exposure verapamil
    Comparison placebo
    Outcome reversion to sinus rhythm