Comparison between beta-blockers and calcium channel blockers in patients with atrial fibrillation according to renal function

Background

Rate control is the most commonly employed first-line management strategy for atrial fibrillation (AF) in patients with chronic kidney disease (CKD). Principal agents used to control heart rate (HR) include beta-blockers (BB) and nondihydropyridine calcium channel blockers (ND-CCB). However, there is a paucity of published studies of the differences between those drugs in CKD patients.

Hypothesis

The present study aimed to investigate the differences, in terms of hospitalizations due to a poor HR control, in patients with AF under a rate-control strategy according to glomerular filtration rate (GFR).

Methods

The study cohort included 2804 AF patients under rate-control regime (BB or ND-CCB) between January 2014 and April 2020. The end point, determined by competing risk regression, was hospitalizations for AF with rapid ventricular response (RVR), slow ventricular response (SVR), and need for pacemaker.

Results

On multivariate analysis, there were no statistical differences between ND-CCB and BB for subjects with GFR > 60 mL/min/1.73 m² (subdistribution heart rate [sHR] 0.850, 95% confidence interval [CI]: 0.61–1.19; p = .442) and GFR 30–59 mL/min/1.73 m² (sHR 1.242, 95% CI: 0.80–1.63; p = .333), while in patients with GFR < 30 mL/min/1.73 m², ND-CCB therapy was associated with increased hospitalizations due to poor HR control (sHR 4.53, 95% CI: 1.19–17.18; p = .026).

Conclusion

In patients with GFR ≥ 30 mL/min/1.73 m², the choice of ND-CCB or BB had no impact on hospitalizations due to poor HR control, while in GFR < 30 mL/min/1.73 m², a possible association was detected. The effects of these drugs on GFR < 30 mL/min/1.73 m² would require further investigation.