VERDICT: The verapamil versus digoxin cardioversion trial: A randomized study on the role of calcium lowering for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation

Introduction: Many relapses of atrial fibrillation (AF) occur, especially d uring the first week(s) after electrical cardioversion (ECV), The aim of th e present study was to compare in a randomized design the efficacy of verap amil (intracellular calcium lowering) versus digoxin (calcium increasing) f or maintenance of sinus rhythm after ECV. Methods and Results: Ninety-seven patients with persistent AF were randomiz ed to verapamil (n = 49) or digoxin (n = 48) for 1 month before and 1 month after ECV. The first month after ECV, patients recorded heart rhythm using daily transtelephonic monitoring. No additional antiarrhythmic drugs were given, Of the 97 patients, 43 patients (20 verapamil) underwent ECV per pro tocol. Median previous AF duration was 18 and 26 days for verapamil and dig oxin, respectively. There were no differences in atrial dimensions and unde rlying heart disease between the two groups. The success rate of ECV was 75 % versus 83% (P = NS). After 1 month, 47% versus 53% (P = NS) had recurrenc e of AF, Median time to recurrence was 5 days (range 0 to 26) versus 8 days (range 2 to 28) (P = NS), respectively. Conclusion: Stand-alone intracellular calcium lowering by verapamil around ECV does not enhance cardioversion outcome.