{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T02:36:18Z","timestamp":1787884578478,"version":"build-2784847793"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1986,2]]},"abstract":"<jats:p>We evaluated the efficacy and the safety of medium-(240 mn\/day) and high-dose (360 mg\/day) diltiazem alone and in combination with digoxin when used for control of heart rate in 12 patients with chronic atrial fibrillation. Medium-dose diltiazem was comparable to therapeutic dose of digoxin at rest (88 +\/- 19 vs 86 +\/- 12 beats\/min) but superior during peak exercise (154 +\/- 23 vs 170 +\/- 20 beats\/min; p less than .05). High-dose diltiazem resulted in better control of heart rate than digoxin both at rest (79 +\/- 17 beats\/min; p less than .05) and exercise (136 +\/- 25 beats\/min; p less than .05) but was associated with side effects in 75% of the patients. Combined therapy of digoxin and diltiazem enhanced the effect of digoxin alone and resulted in significantly better control of heart rate at rest (67 +\/- beats\/min with medium-dose and 65 +\/- beats\/min with high-dose diltiazem) and during peak exercise (132 +\/- 32 and 121 +\/- 24 beats\/min, respectively). However, the difference in heart rate between these two doses was not significant. Reduction of heart rate combined with concomitant effect on blood pressure resulted in a significant fall in pressure-rate product at rest from 10,077 +\/- 1708 mm Hg\/min on digoxin alone to 7877 +\/- 1818 mm Hg\/min after the addition of medium-dose diltiazem (p less than .05) and during exercise form 25,670 +\/- 3606 to 18,439 +\/- 4115 mm Hg\/min (p less than .05). Continued therapy with digoxin combined with diltiazem 240 mg\/day for 21 +\/- 8 days in nine patients showed persistent effect on heart rate and blood pressure without any toxic manifestations or change in serum digoxin (1.5 +\/- 0.4 vs 1.3 +\/- 0.4 ng\/ml) or plasma diltiazem concentrations (204 +\/- 72 vs 232 +\/- 129 ng\/ml). In conclusion, medium-dose diltiazem when combined with digoxin is an effective and safe regimen for the treatment of patients with chronic atrial fibrillation and enhances digoxin-mediated control of heart rate both at rest and during exercise.<\/jats:p>","DOI":"10.1161\/01.cir.73.2.316","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:29:13Z","timestamp":1308342553000},"page":"316-324","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":129,"title":["Efficacy and safety of medium- and high-dose diltiazem alone and in combination with digoxin for control of heart rate at rest and during exercise in patients with chronic atrial fibrillation."],"prefix":"10.1161","volume":"73","author":[{"given":"A","family":"Roth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Mitani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S H","family":"Rahimtoola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U","family":"Elkayam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/pdf\/10.1161\/01.CIR.73.2.316","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T15:10:58Z","timestamp":1715526658000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.CIR.73.2.316"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1986,2]]},"references-count":0,"journal-issue":{"issue":"2","published-print":{"date-parts":[[1986,2]]}},"alternative-id":["10.1161\/01.CIR.73.2.316"],"URL":"https:\/\/doi.org\/10.1161\/01.cir.73.2.316","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[1986,2]]},"assertion":[{"value":"1986-02-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}