Search tips
Search criteria 


Logo of brheartjLink to Publisher's site
Br Heart J. 1990 October; 64(4): 256–260.
PMCID: PMC1024416

Placebo controlled trial of xamoterol versus digoxin in chronic atrial fibrillation.


Thirteen patients in chronic atrial fibrillation with a normal resting heart rate but with exercise tachycardia and episodes of bradycardia were randomised to treatment periods of two weeks on xamoterol (200 mg twice daily), low dose digoxin, or placebo, in a blind crossover study. The results (mean SEM) of symptom scores, a treadmill exercise test, and 24 hour ambulatory electrocardiographic monitoring were obtained. Xamoterol improved symptom scores and controlled exercise heart rate better than digoxin. Xamoterol was better than digoxin or placebo in reducing the heart rate response to exercise and tended to improve exercise duration. Xamoterol, by reducing the daytime maximum hourly heart rate and increasing the night time minimum hourly heart rate, significantly reduced the difference between the two compared with placebo. In contrast, digoxin tended to reduce both the maximum and minimum hourly heart rates through day and night. Both the frequency and duration of ventricular pauses were reduced by xamoterol but tended to increase with digoxin. Xamoterol reduced both the circadian variation in ventricular response to atrial fibrillation and exercise tachycardia by modulating the heart rate according to the prevailing level of sympathetic activity. These changes were translated into symptomatic benefit for the patients studied.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (937K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Pitcher D, Papouchado M, James MA, Rees JR. Twenty four hour ambulatory electrocardiography in patients with chronic atrial fibrillation. Br Med J (Clin Res Ed) 1986 Mar 1;292(6520):594–594. [PMC free article] [PubMed]
  • Rebello R, Brownlee WC. Intermittent ventricular standstill during chronic atrial fibrillation in patients with dizziness or syncope. Pacing Clin Electrophysiol. 1987 Nov;10(6):1271–1276. [PubMed]
  • Nuttall A, Snow HM. The cardiovascular effects of ICI 118,587: A beta 1-adrenoceptor partial agonist. Br J Pharmacol. 1982 Oct;77(2):381–388. [PubMed]
  • Hashimoto T, Shiina A, Toyo-Oka T, Hosoda S, Kondo K. The cardiovascular effects of xamoterol, a beta 1-adrenoceptor partial agonist, in healthy volunteers at rest. Br J Clin Pharmacol. 1986 Mar;21(3):259–265. [PubMed]
  • Wang R, Camm J, Ward D, Washington H, Martin A. Treatment of chronic atrial fibrillation in the elderly, assessed by ambulatory electrocardiographic monitoring. J Am Geriatr Soc. 1980 Dec;28(12):529–534. [PubMed]
  • Salhadin P, Bran M, De Marneffe M, Denolin H. Management of patients with chronic atrial fibrillation. Br J Clin Pharmacol. 1982;13(Suppl 2):295S–296S. [PubMed]
  • James MA, Channer KS, Papouchado M, Rees JR. Improved control of atrial fibrillation with combined pindolol and digoxin therapy. Eur Heart J. 1989 Jan;10(1):83–90. [PubMed]
  • Bjerregaard P. Mean 24 hour heart rate, minimal heart rate and pauses in healthy subjects 40-79 years of age. Eur Heart J. 1983 Jan;4(1):44–51. [PubMed]
  • Petch MC. Lessons from ambulatory electrocardiography. Br Med J (Clin Res Ed) 1985 Sep 7;291(6496):617–618. [PMC free article] [PubMed]
  • CORDAY E, IRVING DW. Effect of cardiac arrhythmias on the cerebral circulation. Am J Cardiol. 1960 Oct;6:803–808. [PubMed]
  • Roth A, Harrison E, Mitani G, Cohen J, Rahimtoola SH, Elkayam U. 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. Circulation. 1986 Feb;73(2):316–324. [PubMed]
  • DiBianco R, Morganroth J, Freitag JA, Ronan JA, Jr, Lindgren KM, Donohue DJ, Larca LJ, Chadda KD, Olukotun AY. Effects of nadolol on the spontaneous and exercise-provoked heart rate of patients with chronic atrial fibrillation receiving stable dosages of digoxin. Am Heart J. 1984 Oct;108(4 Pt 2):1121–1127. [PubMed]
  • Orndahl G, Thulesius O, Hood B. Incidence of persistent atrial fibrillation and conduction defects in coronary heart disease. Am Heart J. 1972 Jul;84(1):120–131. [PubMed]
  • Goldman S, Probst P, Selzer A, Cohn K. Inefficacy of "therapeutic" serum levels of digoxin in controlling the ventricular rate in atrial fibrillation. Am J Cardiol. 1975 May;35(5):651–655. [PubMed]
  • Redfors A. Digoxin dosage and ventricular rate at rest and exercise in patients with atrial fibrillation. Acta Med Scand. 1971 Oct;190(4):321–333. [PubMed]
  • David D, Segni ED, Klein HO, Kaplinsky E. Inefficacy of digitalis in the control of heart rate in patients with chronic atrial fibrillation: beneficial effect of an added beta adrenergic blocking agent. Am J Cardiol. 1979 Dec;44(7):1378–1382. [PubMed]
  • Klein HO, Kaplinsky E. Verapamil and digoxin: their respective effects on atrial fibrillation and their interaction. Am J Cardiol. 1982 Oct;50(4):894–902. [PubMed]
  • Channer KS, Papouchado M, James MA, Pitcher DW, Rees JR. Towards improved control of atrial fibrillation. Eur Heart J. 1987 Feb;8(2):141–147. [PubMed]
  • Atwood JE, Sullivan M, Forbes S, Myers J, Pewen W, Olson HG, Froelicher VF. Effect of beta-adrenergic blockade on exercise performance in patients with chronic atrial fibrillation. J Am Coll Cardiol. 1987 Aug;10(2):314–320. [PubMed]
  • Lewis RV, McDevitt DG. Factors affecting the clinical response to treatment with digoxin and two calcium antagonists in patients with atrial fibrillation. Br J Clin Pharmacol. 1988 May;25(5):603–606. [PubMed]
  • Molajo AO, Coupe MO, Bennett DH. Effect of Corwin (ICI 118587) on resting and exercise heart rate and exercise tolerance in digitalised patients with chronic atrial fibrillation. Br Heart J. 1984 Oct;52(4):392–395. [PMC free article] [PubMed]
  • Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med. 1982 Apr 29;306(17):1018–1022. [PubMed]

Articles from British Heart Journal are provided here courtesy of BMJ Group