Combination Therapy with Digoxin and Diltiazem Controls Ventricular Rate in Chronic Atrial Fibrillation in Dogs Better than Digoxin or Diltiazem Monotherapy: A Randomized Crossover Study in 18 Dogs

Background: Atrial fibrillation (AF) with excessively high ventricular rates (VR) occurs in dogs with advanced heart disease. Rate control improves clinical signs in these patients. Optimal drug therapy and target VR remain poorly defined. Hypothesis: Digoxin‐diltiazem combination therapy reduces VR...

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Bibliographic Details
Published in:	Journal of veterinary internal medicine 2009-05, Vol.23 (3), p.499-508
Main Authors:	Gelzer, A.R.M, Kraus, M.S, Rishniw, M, Moise, N.S, Pariaut, R, Jesty, S.A, Hemsley, S.A
Format:	Article
Language:	eng
Subjects:	24 hours Holter antiarrhythmic Animals Atrial Fibrillation - drug therapy Atrial Fibrillation - veterinary Cardiovascular Agents - administration & dosage Cardiovascular Agents - adverse effects Cardiovascular Agents - therapeutic use Chronic Disease combination drug therapy Cross-Over Studies digoxin Digoxin - administration & dosage Digoxin - adverse effects Digoxin - therapeutic use Diltiazem - administration & dosage Diltiazem - adverse effects Diltiazem - therapeutic use Dog Diseases - drug therapy Dogs Drug Therapy, Combination heart diseases Heart failure Heart Rate - drug effects Rate control
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Summary:	Background: Atrial fibrillation (AF) with excessively high ventricular rates (VR) occurs in dogs with advanced heart disease. Rate control improves clinical signs in these patients. Optimal drug therapy and target VR remain poorly defined. Hypothesis: Digoxin‐diltiazem combination therapy reduces VR more than either drug alone in dogs with high VR AF. Animals: Eighteen client‐owned dogs (>15 kg) with advanced heart disease, AF, and average VR on 24‐hour Holter > 140 beats per minute (bpm). Methods: After baseline Holter recording, dogs were randomized to digoxin or diltiazem monotherapy, or combination therapy. Repeat Holter evaluation was obtained after 2 weeks; dogs were then crossed over to the other arm (monotherapy or combination therapy) for 2 weeks and a third Holter was acquired. Twenty‐four hour average VR, absolute and relative VR changes from baseline, and percent time spent within prespecified VR ranges (>140, 100–140, and
ISSN:	0891-6640 1939-1676