Abstract
Aims: The aim of this study was to compare the effects of four common rate-reducing drugs on levels of cardiac troponin T (cTnT) at rest and after exercise in patients with permanent atrial fibrillation (AF). Methods: We included 60 patients (mean age 71±9 years, 18 women) with permanent AF without ischemic heart disease or congestive heart failure in a cross-over, investigator-blind study. Diltiazem 360 mg, verapamil 240 mg, metoprolol 100 mg and carvedilol 25 mg were administered o.d. for three weeks, in a randomized sequence. At baseline and on the last day of each treatment period, the patients underwent a maximal cardiopulmonary exercise test with blood sampling for high-sensitivity cTnT analyses at rest, at peak exercise and 15 minutes after peak exercise. Results: Levels of cTnT were detectable in all patients. In 22% of the patients the levels of cTnT were above the threshold for diagnosing myocardial infarction. All treatments reduced the levels of cTnT significantly compared to baseline (p<0.001 for all), but there were no significant differences between the different treatments. Levels of cTnT increased significantly in response to exercise testing. View this table: TnT before and after exercise Conclusion: Elevated levels of cTnT are common in patients with permanent AF without ischemic heart disease, even when the ventricular rate is well controlled. This must be accounted for when such patients are evaluated for possible acute coronary syndrome. Even though the mean ventricular rate at baseline was within the limits recommended by guidelines, there was a significant reduction in levels of cTnT by rate-reducing treatment.
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