Heart rate control with nebivolol in patients with tachysystolic atrial fibrillation

Aim. To find out whether selective beta-adrenoblocker nebivolol can be used for heart rate (HR) control in patients with chronic tachysystolic atrial fibrillation. Material. Patients (n=20, 7 men, 13 women, age 47-79 years) with ischemic heart disease and permanent atrial fibrillation (duration 2.5 months - 11 years) admitted to a specialized clinic for diagnosis and treatment of cardiac arrhythmias. All patients had tachycardia throughout 24 hours despite therapy. Methods. Dosing of nebivolol: week 1 - 2.5 mg/day, week 2 7 5 mg/day. if after 2 weeks HR was considered inadequate the dose was increased up to 7.5 mg/day. Holter ECG was registered at baseline and in the end of weeks I and 2 of treatment. Results. After I week of nebivolol (2.5 mg/day) HR decreased: day-time average - from 116.3 +/- 13.4 to 97.2 +/- 14.5, day-time minimal - from 78.1 +/- 13,5 to 71.4 +/- 8.2, day-time maximal - from 154.4 +/- 18.1 to 142.1 +/- 15.5; night-time average - from 83.6 +/- 7.1 to 76.3 +/- 7.14, night-time minimal - from 61.2 +/- 6.7 to 56.6 +/- 5.1, night-time maximal - from 93.5 +/- 10.5 to 88.2 +/- 10.8 bpm. After week 2 when patients received 5 mg/day of nebivolol their HR was: day-time average - 79.6+/-9,8, day-time minimal 65.2 +/- 7.7, day-time maximal - 128.7 +/- 12,2, night-time average - 69.9 +/- 7.6, night-time minimal - 53.1 +/- 4,7, night-time maximal - 80.8 +/- 10.1 bpm. In 2 patients (10%), interruption of nebivolol was required because of atrioventricular block in evening and nocturnal periods. Conclusion. Nebivolol effectively controlled HR in hospitalized patients with chronic atrial fibrillation due to ischemic heart disease. in most patients 5 mg /day was sufficient for attainment of acceptable HR.