Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter

Edward V. Platia, Eric L. Michelson, James K. Porterfield, Gopal Das

Research output: Contribution to journalArticlepeer-review


The effects of esmolol, an ultrashort-acting β blocker, and verapamil were compared in controlling ventricular response in 45 patients with atrial fibrillation or atrial flutter, in a randomized, parallel, open-label study. Patients with either new onset (<48 hours, n = 31) or old onset (> 48 hours, n = 14) of atrial fibrillation or flutter with rapid ventricular rate were stratified to receive esmolol (n = 21) or verapamil (n = 24). Drug efficacy was measured by ventricular rate reduction and conversion to sinus rhythm. The heart rate declined with esmolol from 139 to 100 beats/min (p < 0.001) and with verapamil from 142 to 97 beats/min (p < 0.001). Fifty percent of esmolol-treated patients with new onset of arrhythmias converted to sinus rhythm, whereas only 12% of those who received verapamil converted (p < 0.03). Mild hypotension was observed in both treatment groups. Esmolol compares favorably with verapamil with respect to both efficacy and safety in acutely decreasing ventricular response during atrial fibrillation or flutter. Moreover, conversion to sinus rhythm is significantly more likely with esmolol.

Original languageEnglish (US)
Pages (from-to)925-929
Number of pages5
JournalThe American journal of cardiology
Issue number13
StatePublished - Apr 15 1989

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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