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therapies</span></h1><div class="subtitle">Atrial fibrillation: diagnosis and management</div><p><b>Evidence review I</b></p><p><i>NICE Guideline, No. 196</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2021 Apr</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4043-1</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div></div><div class="bkr_clear"></div></div><div id="niceng196er8.s1"><h2 id="_niceng196er8_s1_">1. Rate control</h2><div id="niceng196er8.s1.1"><h3>1.1. Review question: What is the clinical and cost effectiveness of different non-ablative rate control therapies in people with atrial fibrillation?</h3></div><div id="niceng196er8.s1.2"><h3>1.2. Introduction</h3><p>In atrial fibrillation (AF) ventricular rate control is the one of the cornerstones of therapy and is usually sufficient to alleviate symptoms due to AF. AF with fast ventricular rates is a major contributing factor exercise limitation and disability. Unabated fast AF may lead to left ventricular dysfunction and heart failure.</p><p>The ventricular rate response to atrial fibrillation is dependent on atrio-ventricular (AV) node conduction and is influenced by autonomic tone. Alleviation of symptoms requires appropriate ventricular rate control both at rest and during exertion when rate response to AF may increase disproportionately. AV node conduction in response to AF varies considerably and some patients may not require rate control.</p><p>Non-ablative rate control in both the acute and non-acute settings is achieved by categories of drugs that slow AV node conduction including beta blockers, rate limiting calcium channel blockers, and digoxin. Amiodarone also slows AV node conduction and maybe used in the acute phase particularly where there is evidence of haemodynamic instability or severely impaired left ventricular (LV) function. These drugs may be used alone but combinations are often required. Even so, rate control remains challenging particularly when choice is limited drug intolerance and patient factors (e.g. rate limiting calcium channel blockers are contraindicated in severe LV dysfunction). This evidence review aims to assess the effectiveness of these different AV node slowing drugs in the rate control of atrial fibrillation both in the acute and non-acute settings.</p></div><div id="niceng196er8.s1.3"><h3>1.3. PICO table</h3><p>For full details see the review protocol in <a href="#niceng196er8.appa">Appendix A</a>:.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er8tab1"><a href="/books/NBK571338/table/niceng196er8.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er8tab1" rid-ob="figobniceng196er8tab1"><img class="small-thumb" src="/books/NBK571338/table/niceng196er8.tab1/?report=thumb" src-large="/books/NBK571338/table/niceng196er8.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng196er8.tab1"><a href="/books/NBK571338/table/niceng196er8.tab1/?report=objectonly" target="object" rid-ob="figobniceng196er8tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng196er8.s1.4"><h3>1.4. Methods and process</h3><p>This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng196er8.ref103" rid="niceng196er8.ref103"><sup>103</sup></a>Methods specific to this review question are described in the review protocol in <a href="#niceng196er8.appa">Appendix A</a>:.</p><p>Declarations of interest were recorded according to NICE’s 2018conflicts of interest policy.</p></div><div id="niceng196er8.s1.5"><h3>1.5. Clinical evidence</h3><div id="niceng196er8.s1.5.1"><h4>1.5.1. Included studies</h4><p>A search was conducted to identify randomised controlled trials or systematic reviews of randomised controlled trials comparing different strategies for rate control in non-valvular atrial fibrillation(NVAF), including beta-blockers, calcium channel blockers, digoxin, amiodarone and any combinations of these agents. Five studies(from six papers)were included in the review;<a class="bibr" href="#niceng196er8.ref57" rid="niceng196er8.ref57"><sup>57</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er8.ref74" rid="niceng196er8.ref74"><sup>74</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er8.ref76" rid="niceng196er8.ref76"><sup>76</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er8.ref135" rid="niceng196er8.ref135"><sup>135</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er8.ref140" rid="niceng196er8.ref140"><sup>140</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er8.ref151" rid="niceng196er8.ref151"><sup>151</sup></a>these are summarised in <a class="figpopup" href="/books/NBK571338/table/niceng196er8.tab2/?report=objectonly" target="object" rid-figpopup="figniceng196er8tab2" rid-ob="figobniceng196er8tab2">Table 2</a> below. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK571338/table/niceng196er8.tab3/?report=objectonly" target="object" rid-figpopup="figniceng196er8tab3" rid-ob="figobniceng196er8tab3">Table 3</a>).</p><p>Studies were included in this review only if the primary aim of the interventions was for rate control, and not for the restoration or control of sinus rhythm. The majority of the included studies employed intravenous administration of the drugs rather than oral doses and were set in secondary care, including over half in the emergency department for the treatment of acute AF. The included studies covered the following comparisons between the interventions listed in the protocol for this review:
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<ul><li class="half_rhythm"><div>Four studies compared amiodarone with digoxin.<a class="bibr" href="#niceng196er8.ref57" rid="niceng196er8.ref57"><sup>57</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er8.ref135" rid="niceng196er8.ref135"><sup>135</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er8.ref140" rid="niceng196er8.ref140"><sup>140</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er8.ref151" rid="niceng196er8.ref151"><sup>151</sup></a>Three of these used intravenous administration with one using oral administration.</div></li><li class="half_rhythm"><div>One study (two papers) compared beta-blockers (carvedilol) with digoxin<a class="bibr" href="#niceng196er8.ref74" rid="niceng196er8.ref74"><sup>74</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er8.ref76" rid="niceng196er8.ref76"><sup>76</sup></a>. The study design was complex and involved two phases – one where carvedilol or placebo was initiated and a second where digoxin was either continued or discontinued to compare between a group receiving carvedilol alone and another group receiving digoxin alone at the end of the study. This study used oral administration of the drugs.</div></li></ul></p><p>Not all of the studies explicitly stated that they covered a NVAF population; those with valvular disease as an exclusion criterion or those with no mention of concomitant valve disease within the population were included in the review, while studies where it was clear >10% of the population had experienced concomitant valve disease were excluded from the review.</p><p>It is also noted that studies that included intravenous use of diltiazem as one of the comparators were not included in the review, as this is not available for use in the UK in this form.</p><p>See also the study selection flow chart in <a href="#niceng196er8.appc">Appendix C</a>:, study evidence tables in <a href="#niceng196er8.appd">Appendix D</a>:, forest plots in <a href="#niceng196er8.appe">Appendix E</a>: and GRADE tables in <a href="#niceng196er8.apph">Appendix H</a>:.</p></div><div id="niceng196er8.s1.5.2"><h4>1.5.2. Excluded studies</h4><p>See the excluded studies list in <a href="#niceng196er8.appi">Appendix I</a>.</p></div><div id="niceng196er8.s1.5.3"><h4>1.5.3. Summary of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er8tab2"><a href="/books/NBK571338/table/niceng196er8.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er8tab2" rid-ob="figobniceng196er8tab2"><img class="small-thumb" src="/books/NBK571338/table/niceng196er8.tab2/?report=thumb" src-large="/books/NBK571338/table/niceng196er8.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="niceng196er8.tab2"><a href="/books/NBK571338/table/niceng196er8.tab2/?report=objectonly" target="object" rid-ob="figobniceng196er8tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#niceng196er8.appd">Appendix D</a>:for full evidence tables.</p></div><div id="niceng196er8.s1.5.4"><h4>1.5.4. Quality assessment of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er8tab3"><a href="/books/NBK571338/table/niceng196er8.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er8tab3" rid-ob="figobniceng196er8tab3"><img class="small-thumb" src="/books/NBK571338/table/niceng196er8.tab3/?report=thumb" src-large="/books/NBK571338/table/niceng196er8.tab3/?report=previmg" alt="Table 3. Clinical evidence summary: Amiodarone vs. digoxin." /></a><div class="icnblk_cntnt"><h4 id="niceng196er8.tab3"><a href="/books/NBK571338/table/niceng196er8.tab3/?report=objectonly" target="object" rid-ob="figobniceng196er8tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Amiodarone vs. digoxin. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er8tab4"><a href="/books/NBK571338/table/niceng196er8.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er8tab4" rid-ob="figobniceng196er8tab4"><img class="small-thumb" src="/books/NBK571338/table/niceng196er8.tab4/?report=thumb" src-large="/books/NBK571338/table/niceng196er8.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: Beta-blockers vs. digoxin." /></a><div class="icnblk_cntnt"><h4 id="niceng196er8.tab4"><a href="/books/NBK571338/table/niceng196er8.tab4/?report=objectonly" target="object" rid-ob="figobniceng196er8tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Beta-blockers vs. digoxin. </p></div></div><p>See <a href="#niceng196er8.appf">Appendix F</a>:for full GRADE tables.</p></div></div><div id="niceng196er8.s1.6"><h3>1.6. Economic evidence</h3><div id="niceng196er8.s1.6.1"><h4>1.6.1. Included studies</h4><p>No health economic studies were included.</p></div><div id="niceng196er8.s1.6.2"><h4>1.6.2. Excluded studies</h4><p>No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng196er8.appg">Appendix G</a>:.</p></div><div id="niceng196er8.s1.6.3"><h4>1.6.3. Unit costs</h4><p>Relevant drug unit costs are provided in <a class="figpopup" href="/books/NBK571338/table/niceng196er8.tab5/?report=objectonly" target="object" rid-figpopup="figniceng196er8tab5" rid-ob="figobniceng196er8tab5">Table 5</a>to aid consideration of costeffectiveness.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er8tab5"><a href="/books/NBK571338/table/niceng196er8.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er8tab5" rid-ob="figobniceng196er8tab5"><img class="small-thumb" src="/books/NBK571338/table/niceng196er8.tab5/?report=thumb" src-large="/books/NBK571338/table/niceng196er8.tab5/?report=previmg" alt="Table 5. Drug unit costs." /></a><div class="icnblk_cntnt"><h4 id="niceng196er8.tab5"><a href="/books/NBK571338/table/niceng196er8.tab5/?report=objectonly" target="object" rid-ob="figobniceng196er8tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Drug unit costs. </p></div></div></div></div><div id="niceng196er8.s1.7"><h3>1.7. The committee’s discussion of the evidence</h3><div id="niceng196er8.s1.7.1"><h4>1.7.1. Interpreting the evidence</h4><div id="niceng196er8.s1.7.1.1"><h5>1.7.1.1. The outcomes that matter most</h5><p>All outcomes listed in the protocol for this review, which comprised health-related quality of life, mortality, hospitalisation, heart failure/exacerbation of heart failure and failure of non-ablative rate control, were considered by the committee to be critical for decision-making. No additional important outcomes were specified in the protocol.</p><p>In this review, no clinical evidence was identified for the hospitalisation outcome for any of the comparisons specified in the protocol.</p></div><div id="niceng196er8.s1.7.1.2"><h5>1.7.1.2. The quality of the evidence</h5><p>The quality of the evidence for all outcomes included in this review was of very low quality according to GRADE analysis. The primary reasons for this were a very high risk of bias due to issues with selection and blinding of participants and attrition, as well as imprecision detected for all included outcomes.</p><p>Inconsistency, which refers to the presence of heterogeneity between effects across different studies in a meta-analysis, was also an issue for one of the outcomes in the amiodarone vs. digoxin comparison.</p><p>Limited evidence was identified for this review, and the available evidence only covered two comparisons: amiodarone vs. digoxin and beta blockers vs. digoxin. In terms of interpreting the evidence, imprecision made it difficult for the committee to determine the true effect of the interventions relative to one another, as there was too much uncertainty. This uncertainty was exacerbated by the fact that for most of the reported outcomes, pooling of multiple studies was not possible and effect sizes were based on only one study with small numbers of participants. These limitations in the amount and quality of the evidence meant that the committee did not feel able to change existing recommendations based on the evidence, and instead changes were made based on consensus and current practice.</p></div><div id="niceng196er8.s1.7.1.3"><h5>1.7.1.3. Benefits and harms</h5><p>The evidence included in this review was obtained from five RCTs, with evidence available for the comparisons between beta-blockers and digoxin, and amiodarone and digoxin.</p><p>For the amiodarone vs. digoxin comparison, there was some evidence to suggest a benefit of amiodarone over digoxin in terms of failure of non-ablative rate control, with a meta-analysis consisting of three studies indicating fewer failures in the amiodarone group compared with the digoxin group. However, concerns were raised by the committee about whether the time-point at which failure of rate control was measured was suitable to be able to detect effects of digoxin; one study measured rate control failure at 30 min post-initial dose, which was considered to be too short to measure an effect of digoxin and therefore the time-point at which this outcome was measured may have been biased towards amiodarone for this study.</p><p>There was no clear evidence for any of the other outcomes reported for this comparison. One study provided data on the quality of life of those receiving oral doses of amiodarone or digoxin; however, this was based on a very small number of participants and there was too much variability in effect sizes for most of the quality of life domains to determine whether a difference existed between the two groups. Additionally, the committee noted that the composite mental and physical scores that are usually reported for the SF-36 quality of life scoring system had not been reported in this study, suggesting that there was likely to be no important difference between the two groups overall and this may be why these composite scores were not reported in the study. Similarly, no strong evidence favouring either amiodarone or digoxin in studies with intravenous dosing in the emergency department was available for in-hospital mortality or heart failure onset outcomes, with either no clinical difference being reported or substantial variation in the effect estimate making it difficult to determine the true effect.</p><p>For the beta-blockers vs. digoxin comparison, only one study was available, which compared oral dosing with carvedilol or digoxin. Although point estimates appeared to favour digoxin in terms of mortality and worsening of heart failure symptoms during the second phase of this trial, the wide confidence intervals meant that there was substantial uncertainty in the true effect.</p><p>As the committee considered the evidence to be insufficient to support significant changes to the current recommendations in this area, the committee instead amended the existing recommendations based on consensus and current practice. The committee noted that recommendations for chronic heart failure were published in 2018 (NICE guideline NG106) and when considering drug therapy in those with atrial fibrillation and chronic heart failure, clinicians should refer to the chronic heart failure guideline for the use of calcium channel blockers, as it advises that calcium channel blockers such as diltiazem and verapamil be avoided in those with heart failure and reduced left ventricular ejection fraction. Additionally, the chronic heart failure guideline (NICE guideline NG106) had already reviewed the evidence for beta-blockers vs. placebo in those with atrial fibrillation and heart failure by including an individual patient data meta-analysis of atrial fibrillation subsets of heart failure trials; no recommendations were made regarding the use of beta-blockers in those with atrial fibrillation and heart failure. There was some evidence of a small increase in all-cause mortality and stroke but the chronic heart failure committee were not confidence in the effect estimate due to the presence of very serious imprecision. The evidence did not show a clinical important reduction in the number of heart failure hospitalisations. Due to the uncertainty in the evidence the committee made a research recommendation. Therefore, to avoid contradicting decisions made in NG106 based on the same set of evidence, the individual patient data meta-analysis mentioned above was not included in the review, and it was agreed that referring to NG106 for beta-blocker use in those with atrial fibrillation and chronic heart failure was preferable.</p><p>The existing recommendation of beta-blockers or rate-limiting calcium channel blockers as the choice for initial rate control treatment in those requiring a rate control strategy was retained by the committee as they agreed that this recommendation was still current practice and there was insufficient evidence to suggest an alternative recommendation, with potential adverse events of other alternative options being highlighted. The committee agreed that the choice should still be made based on the symptoms, heart rate, comorbidities and preferences of those being treated. The committee also agreed with the existing recommendations for this area concerning combination therapy options if initial monotherapy fails and the decision not to use amiodarone long-term, as the evidence included in the review was insufficient to suggest otherwise and there were significant concerns about the serious side effects associated with long-term use of amiodarone. However, the committee highlighted that digoxin monotherapy in those with non-paroxysmal atrial fibrillation was not always limited to people that are sedentary and may also be considered in those with comorbidities or because of patient preferences that prevent the use of other rate control drugs. The reasoning given by the previous guideline committee to limit digoxin use in non-paroxysmal atrial fibrillation to those that are sedentary was due to concerns about reduced effectiveness during exercise. However, the current guideline committee agreed that there was not considered to be any evidence against considering digoxin in these additional groups and a number of committee members confirmed that from their experience digoxin was sometimes considered in those that were not sedentary if other options for monotherapy were not suitable. The committee were aware that some clinicians feel that digoxin monotherapy is often better than alternatives for improving symptoms; however, the lack of evidence currently available meant that the recommendation for digoxin was not expanded to cover further groups of people.</p></div></div><div id="niceng196er8.s1.7.2"><h4>1.7.2. Cost effectiveness and resource use</h4><p>No relevant health economic analyses were identified for this review. The unit costs of rate control drugs were presented. The unit costs are low and although there was limited clinical evidence, the committee felt that these costs were likely to be offset by the gains in quality of life. In discussion, the committee noted that the drugs considered are already in widespread use in current practice, and as such the cost impact of the recommendation is likely to be low. The committee considered other factors which may influence the resource use associated with any of the drugs. In particular, they discussed the serious adverse effects associated with the long-term use of amiodarone (including thyroid, lung and nerve damage), many of which are irreversible. The committee noted amiodarone requires intensive monitoring which has an associated cost. Furthermore, if a patient experiences these serious adverse events then there would be a significant cost to both the patient in terms of prognosis and NHS in terms of treatment and long-term management.</p><p>Due to the limited evidence available in the clinical review and lack of health economic evidence the committee decided to keep the existing recommendations, making only small amendments and additions. The consensus-based edits included cross referring to the chronic heart failure guideline, where the use of calcium channel blockers and beta blockers is not recommended in people with AF and concomitant heart failure. This is further supported by the acute heart failure guideline which advises caution when using beta blockers and that calcium channel blockers should not be used. This addition is not expected to have any resource impact on the NHS as this should already be current practice. The second amendment is expanding the population for whom digoxin monotherapy is considered to include those with comorbidities and/or patient preferences that rule out other rate-limiting drug options. The committee noted that this sometimes occurs in current practice and they do not anticipate this change in recommendation to have a significant resource impact to NHS resources.</p><div id="niceng196er8.s1.7.2.1"><h5>1.7.2.1. Other factors the committee took into account</h5><p>The committee was aware of a recently published study in recent-onset (acute) AF, which indicated that rate control with delayed cardioversion if AF did not resolve within 48 h was non-inferior to early cardioversion. This supports the use of rate control, with delayed cardioversion if required, as an appropriate treatment strategy in acute AF, meaning its inclusion as an option in the recommendations for acute AF rate control was considered to be appropriate.</p></div></div></div></div><div id="niceng196er8.rl.r1"><h2 id="_niceng196er8_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng196er8.ref1">Al-Khatib
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et al. Beta-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias. Anesthesiology. 1998; 89(5):1052–1059 [<a href="https://pubmed.ncbi.nlm.nih.gov/9821992" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9821992</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="niceng196er8.ref10">Bavishi
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C, Khan
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AR, Ather
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S. Digoxin in patients with atrial fibrillation and heart failure: a meta-analysis. International Journal of Cardiology. 2015; 188(1):99–101 [<a href="https://pubmed.ncbi.nlm.nih.gov/25900519" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25900519</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="niceng196er8.ref11">Bellandi
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F, Dabizzi
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RP, Niccoli
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L, Cantini
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F. Propafenone and sotalol in the prevention of paroxysmal atrial fibrillation: long-term safety and efficacy study. Current Therapeutic Research - Clinical and Experimental. 1995; 56(11):1154–1168</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="niceng196er8.ref12">Bianconi
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|
L, Castro
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A, Dinelli
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M, Alboni
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P, Pappalardo
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A, Richiardi
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E
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et al. Comparison of intravenously administered dofetilide versus amiodarone in the acute termination of atrial fibrillation and flutter. A multicentre, randomized, double-blind, placebo-controlled study. European Heart Journal. 2000; 21(15):1265–1273 [<a href="https://pubmed.ncbi.nlm.nih.gov/10924317" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10924317</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="niceng196er8.ref13">Bianconi
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L, Mennuni
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M. Comparison between propafenone and digoxin administered intravenously to patients with acute atrial fibrillation. American Journal of Cardiology. 1998; 82(5):584–588 [<a href="https://pubmed.ncbi.nlm.nih.gov/9732884" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9732884</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="niceng196er8.ref14">Blevins
|
|
RD, Kerin
|
|
NZ, Benaderet
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D, Frumin
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H, Faitel
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K, Jarandilla
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R
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|
|
S, Coccolini
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S, Dalla Valle
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G, Guadagni
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C, Bellanti
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G, Graziani
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A. Paroxysmal atrial fibrillation: is prophylaxis always helpful?
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Current Therapeutic Research - Clinical and Experimental. 1990; 48(1):80–84</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="niceng196er8.ref17">Brodsky
|
|
M, Saini
|
|
R, Bellinger
|
|
R, Zoble
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R, Weiss
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R, Powers
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L. Comparative effects of the combination of digoxin and dl-sotalol therapy versus digoxin monotherapy for control of ventricular response in chronic atrial fibrillation. American Heart Journal. 1994; 127(3):572–577 [<a href="https://pubmed.ncbi.nlm.nih.gov/8122604" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8122604</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="niceng196er8.ref18">Capucci
|
|
A, Boriani
|
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G, Rubino
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I, Della Casa
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S, Sanguinetti
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M, Magnani
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B. A controlled study on oral propafenone versus digoxin plus quinidine in converting recent onset atrial fibrillation to sinus rhythm. International Journal of Cardiology. 1994; 43(3):305–313 [<a href="https://pubmed.ncbi.nlm.nih.gov/8181888" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8181888</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="niceng196er8.ref19">Chamaria
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|
S, Desai
|
|
AM, Reddy
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PC, Olshansky
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B, Dominic
|
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P. Digoxin use to control ventricular rate in patients with atrial fibrillation and heart failure is not associated with increased mortality. Cardiology Research and Practice. 2015; 2015:1–10 [<a href="/pmc/articles/PMC4691628/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4691628</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26788401" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26788401</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="niceng196er8.ref20">Cheiman
|
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DM, Shea
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BF, Kelly
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RA. Treatment of supraventricular tachyarrhythmias with intravenous calcium channel blockers: are subtle differences worth the cost?
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Pharmacotherapy. 1996; 16(5):861–868 [<a href="https://pubmed.ncbi.nlm.nih.gov/8888080" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8888080</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="niceng196er8.ref21">Chen
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|
K, Qin
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L, Lu
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X, Xia
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T, Gu
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Q. Amiodarone in the treatment of atrial fibrillation of patients with rheumatic heart disease after valve replacement. Pakistan Journal of Medical Sciences. 2019; 35(4):918–922 [<a href="/pmc/articles/PMC6659075/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6659075</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31372117" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31372117</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="niceng196er8.ref22">Cheng
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JW, Rybak
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I. Use of digoxin for heart failure and atrial fibrillation in elderly patients. American Journal of Geriatric Pharmacotherapy. 2010; 8(5):419–427 [<a href="https://pubmed.ncbi.nlm.nih.gov/21335295" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21335295</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="niceng196er8.ref23">CIBIS Investigators and Committees. A randomized trial of beta-blockade in heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS). CIBIS Investigators and Committees. Circulation. 1994; 90(4):1765–1773 [<a href="https://pubmed.ncbi.nlm.nih.gov/7923660" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7923660</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="niceng196er8.ref24">Cleland
|
|
JG, Pennell
|
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DJ, Ray
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SG, Coats
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AJ, Macfarlane
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PW, Murray
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GD
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|
|
AD, Siddins
|
|
M, Rosenfeldt
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FL, Salamonsen
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R, McConaghy
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L, Marasco
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S
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|
|
G, Blatt
|
|
A, Kaluski
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E, Metzkor-Cotter
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E, Koren
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M, Litinski
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I
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JC, Gardiner
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P, Reid
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DS, Newell
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DJ, Campbell
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RW. Amiodarone in the management of atrial fibrillation complicating myocardial infarction. British Journal of Clinical Practice Supplement. 1986; 44:155–163 [<a href="https://pubmed.ncbi.nlm.nih.gov/3089255" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3089255</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="niceng196er8.ref28">Cowan
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JC, Gardiner
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P, Reid
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DS, Newell
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DJ, Campbell
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RW. A comparison of amiodarone and digoxin in the treatment of atrial fibrillation complicating suspected acute myocardial infarction. Journal of Cardiovascular Pharmacology. 1986; 8(2):252–256 [<a href="https://pubmed.ncbi.nlm.nih.gov/2422461" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2422461</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="niceng196er8.ref29">Cybulski
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J, Kulakowski
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P, Makowska
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E, Czepiel
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A, Sikora-Frac
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M, Ceremuzynski
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L. Intravenous amiodarone is safe and seems to be effective in termination of paroxysmal supraventricular tachyarrhythmias. Clinical Cardiology. 1996; 19(7):563–566 [<a href="https://pubmed.ncbi.nlm.nih.gov/8818437" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8818437</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="niceng196er8.ref30">Dargie
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HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001; 357(9266):1385–1390 [<a href="https://pubmed.ncbi.nlm.nih.gov/11356434" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11356434</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="niceng196er8.ref31">Dargie
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HJL, P. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999; 353(9146):9–13 [<a href="https://pubmed.ncbi.nlm.nih.gov/10023943" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10023943</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="niceng196er8.ref32">Daubert
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C, Mabo
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P, Gras
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D, Leclercq
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C. Clinical role of d-sotalol and d,l-sotalol in supraventricular arrhythmias, including pre-excitation. European Heart Journal. 1993; 14 (Suppl H):67–73 [<a href="https://pubmed.ncbi.nlm.nih.gov/7904939" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7904939</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="niceng196er8.ref33">Deedwania
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PC, Singh
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BN, Ellenbogen
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K, Fisher
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S, Fletcher
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R, Singh
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SN. Spontaneous conversion and maintenance of sinus rhythm by amiodarone in patients with heart failure and atrial fibrillation: observations from the veterans affairs congestive heart failure survival trial of antiarrhythmic therapy (CHF-STAT). The Department of Veterans Affairs CHF-STAT Investigators. Circulation. 1998; 98(23):2574–2579 [<a href="https://pubmed.ncbi.nlm.nih.gov/9843465" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9843465</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="niceng196er8.ref34">Delle Karth
|
|
G, Geppert
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A, Neunteufl
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T, Priglinger
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U, Haumer
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M, Gschwandtner
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M
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C, Cikriklar
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HI, Engindeniz
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Z, Cebicci
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H, Atar
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N, Guler
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V
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VC, Plumb
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VJ. Intravenous diltiazem in patients with atrial fibrillation/atrial flutter. A pilot dose-response study. Drug Investigation. 1991; 3(1):8–13</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="niceng196er8.ref37">Donovan
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KD, Power
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BM, Hockings
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BE, Dobb
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GJ, Lee
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KY. Intravenous flecainide versus amiodarone for recent-onset atrial fibrillation. American Journal of Cardiology. 1995; 75(10):693–697 [<a href="https://pubmed.ncbi.nlm.nih.gov/7900662" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7900662</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="niceng196er8.ref38">Dorian
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P, Paquette
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M, Newman
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D, Green
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M, Connolly
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SJ, Talajic
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M
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|
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EJ, Domanski
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MJ, Krause-Steinrauf
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H, Bristow
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MR, Lavori
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PW. A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. New England Journal of Medicine. 2001; 344(22):1659–1667 [<a href="https://pubmed.ncbi.nlm.nih.gov/11386264" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11386264</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="niceng196er8.ref40">Ellenbogen
|
|
KA, Dias
|
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VC, Cardello
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FP, Strauss
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WE, Simonton
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CA, Pollak
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SJ
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KA, Dias
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VC, Plumb
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VJ, Heywood
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JT, Mirvis
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DM. A placebo-controlled trial of continuous intravenous diltiazem infusion for 24-hour heart rate control during atrial fibrillation and atrial flutter: a multicenter study. Journal of the American College of Cardiology. 1991; 18(4):891–897 [<a href="https://pubmed.ncbi.nlm.nih.gov/1894861" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1894861</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="niceng196er8.ref42">Falk
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RH, Knowlton
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AA. Is digoxin necessary in converting recent-onset atrial fibrillation?
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RH, Knowlton
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AA, Bernard
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SA, Gotlieb
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NE, Battinelli
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NJ. Digoxin for converting recent-onset atrial fibrillation to sinus rhythm. A randomized, double-blinded trial. Annals of Internal Medicine. 1987; 106(4):503–506 [<a href="https://pubmed.ncbi.nlm.nih.gov/3548521" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3548521</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="niceng196er8.ref44">Fauchier
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|
L, Grimard
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C, Pierre
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B, Nonin
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E, Gorin
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L, Rauzy
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B
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|
|
G, Lopes
|
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RD, Hylek
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E, Wojdyla
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DM, Thomas
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L, Al-Khatib
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SM
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|
|
MD, Shibata
|
|
MC, Coats
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AJ, Van Veldhuisen
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DJ, Parkhomenko
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A, Borbola
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N, Lafuente-Lafuente
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C, Mitchell
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S, Eckert
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L, Reynolds
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M. Mixed treatment comparison of dronedarone, amiodarone, sotalol, flecainide, and propafenone, for the management of atrial fibrillation. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology. 2011; 13(3):329–345 [<a href="https://pubmed.ncbi.nlm.nih.gov/21227948" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21227948</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="niceng196er8.ref48">Fromm
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C, Suau
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SJ, Cohen
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V, Likourezos
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A, Jellinek-Cohen
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S, Rose
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J
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DM, Kim
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SG, Ferrick
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KJ, Roth
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JA, Fisher
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JD. Efficacy and safety of sotalol in patients with refractory atrial fibrillation or flutter. American Heart Journal. 1997; 134(2 Pt 1):155–160 [<a href="https://pubmed.ncbi.nlm.nih.gov/9313591" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9313591</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="niceng196er8.ref50">Galve
|
|
E, Rius
|
|
T, Ballester
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R, Artaza
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MA, Arnau
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JM, Garcia-Dorado
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IF, Lewis
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WR, Dias
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VC, Heywood
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JT, Pedersen
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WR. Intravenous diltiazem for the treatment of patients with atrial fibrillation or flutter and moderate to severe congestive heart failure. American Journal of Cardiology. 1994; 74(9):884–889 [<a href="https://pubmed.ncbi.nlm.nih.gov/7977118" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7977118</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>52.</dt><dd><div class="bk_ref" id="niceng196er8.ref52">Gonzalez
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R, Scheinman
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MM. Treatment of supraventricular arrhythmias with intravenous and oral verapamil. Chest. 1981; 80(4):465–470 [<a href="https://pubmed.ncbi.nlm.nih.gov/7023864" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7023864</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>53.</dt><dd><div class="bk_ref" id="niceng196er8.ref53">Hassan
|
|
S, Slim
|
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AM, Kamalakannan
|
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D, Khoury
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R, Kakish
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E, Maria
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et al. Conversion of atrial fibrillation to sinus rhythm during treatment with intravenous esmolol or diltiazem: a prospective, randomized comparison. Journal of Cardiovascular Pharmacology and Therapeutics. 2007; 12(3):227–231 [<a href="https://pubmed.ncbi.nlm.nih.gov/17875950" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17875950</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>54.</dt><dd><div class="bk_ref" id="niceng196er8.ref54">Hemels
|
|
ME, Van Noord
|
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T, Crijns
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HJ, Van Veldhuisen
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DJ, Veeger
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NJ, Bosker
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HA
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JT. Calcium channel blockers for heart rate control in atrial fibrillation complicated by congestive heart failure. Canadian Journal of Cardiology. 1995; 11(9):823–826 [<a href="https://pubmed.ncbi.nlm.nih.gov/7585281" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7585281</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>56.</dt><dd><div class="bk_ref" id="niceng196er8.ref56">Hjalmarson
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A. Arrhythmias. American Journal of Cardiology. 1985; 56(14):35G–38G [<a href="https://pubmed.ncbi.nlm.nih.gov/3904392" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3904392</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>57.</dt><dd><div class="bk_ref" id="niceng196er8.ref57">Hofmann
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R, Steinwender
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C, Kammler
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J, Kypta
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A, Leisch
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F. Effects of a high dose intravenous bolus amiodarone in patients with atrial fibrillation and a rapid ventricular rate. International Journal of Cardiology. 2006; 110(1):27–32 [<a href="https://pubmed.ncbi.nlm.nih.gov/16046015" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16046015</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>58.</dt><dd><div class="bk_ref" id="niceng196er8.ref58">Hornestam
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B, Held
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P, Edvardsson
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N. Effects of digoxin on electrocardiogram in patients with acute atrial fibrillation--a randomized, placebo-controlled study. Digitalis in Acute Atrial Fibrillation (DAAF) Trial Group. Clinical Cardiology. 1999; 22(2):96–102 [<a href="/pmc/articles/PMC6656138/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6656138</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10068846" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10068846</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>59.</dt><dd><div class="bk_ref" id="niceng196er8.ref59">Hou
|
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ZY, Chang
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MS, Chen
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CY, Tu
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MS, Lin
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SL, Chiang
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HT
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et al. Acute treatment of recent-onset atrial fibrillation and flutter with a tailored dosing regimen of intravenous amiodarone. A randomized, digoxin-controlled study. European Heart Journal. 1995; 16(4):521–528 [<a href="https://pubmed.ncbi.nlm.nih.gov/7671898" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7671898</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>60.</dt><dd><div class="bk_ref" id="niceng196er8.ref60">Ibrahim
|
|
I, Kuan
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WS, Yau
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YW, Chua
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MT, Lin
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Z, Cheng
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L
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|
|
H, Atarashi
|
|
H, Okumura
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|
K, Yamashita
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T, Fukuzawa
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M, Shiosakai
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K
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et al. Heart rate control by carvedilol in Japanese patients with chronic atrial fibrillation: The AF Carvedilol study. Journal of Cardiology. 2017; 69(1):293–301 [<a href="https://pubmed.ncbi.nlm.nih.gov/27364549" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27364549</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>62.</dt><dd><div class="bk_ref" id="niceng196er8.ref62">Jafri
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SH, Cerecedo-Lopez
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CD, Warsi
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AI, Xu
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J. Diltiazem versus metoprolol for the management of atrial fibrillation: A systematic review and meta-analysis. Journal of the American College of Cardiology. 2020; 75(11):436</div></dd></dl><dl class="bkr_refwrap"><dt>63.</dt><dd><div class="bk_ref" id="niceng196er8.ref63">Joglar
|
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JA, Acusta
|
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AP, Shusterman
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NH, Ramaswamy
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K, Kowal
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RC, Barbera
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SJ
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et al. Effect of carvedilol on survival and hemodynamics in patients with atrial fibrillation and left ventricular dysfunction: retrospective analysis of the US Carvedilol Heart Failure Trials Program. American Heart Journal. 2001; 142(3):498–501 [<a href="https://pubmed.ncbi.nlm.nih.gov/11526364" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11526364</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>64.</dt><dd><div class="bk_ref" id="niceng196er8.ref64">Jordaens
|
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L, Trouerbach
|
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J, Calle
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P, Tavernier
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R, Derycke
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E, Vertongen
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P
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et al. Conversion of atrial fibrillation to sinus rhythm and rate control by digoxin in comparison to placebo. European Heart Journal. 1997; 18(4):643–648 [<a href="https://pubmed.ncbi.nlm.nih.gov/9129896" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9129896</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>65.</dt><dd><div class="bk_ref" id="niceng196er8.ref65">Joseph
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AP, Ward
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MR. A prospective, randomized controlled trial comparing the efficacy and safety of sotalol, amiodarone, and digoxin for the reversion of new-onset atrial fibrillation. Annals of Emergency Medicine. 2000; 36(1):1–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/10874228" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10874228</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>66.</dt><dd><div class="bk_ref" id="niceng196er8.ref66">Kakihana
|
|
Y, Nishida
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O, Taniguchi
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T, Okajima
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M, Morimatsu
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H, Ogura
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H
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et al. Efficacy and safety of landiolol, an ultra-short-acting beta1-selective antagonist, for treatment of sepsis-related tachyarrhythmia (J-Land 3S): a multicentre, open-label, randomised controlled trial. The Lancet Respiratory Medicine. 2020; 8(9):863–872 [<a href="https://pubmed.ncbi.nlm.nih.gov/32243865" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32243865</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>67.</dt><dd><div class="bk_ref" id="niceng196er8.ref67">Kamali
|
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A, Sanatkar
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A, Sharifi
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M, Moshir
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E. Evaluation of amiodarone versus metoprolol in treating atrial fibrillation after coronary artery bypass grafting. Interventional Medicine and Applied Science. 2017; 9(2):51–55 [<a href="/pmc/articles/PMC5598126/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5598126</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28932497" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28932497</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>68.</dt><dd><div class="bk_ref" id="niceng196er8.ref68">Kanji
|
|
S, Stewart
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R, Fergusson
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DA, McIntyre
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L, Turgeon
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AF, Hebert
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PC. Treatment of new-onset atrial fibrillation in noncardiac intensive care unit patients: a systematic review of randomized controlled trials. Critical Care Medicine. 2008; 36(5):1620–1624 [<a href="https://pubmed.ncbi.nlm.nih.gov/18434899" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18434899</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>69.</dt><dd><div class="bk_ref" id="niceng196er8.ref69">Kao
|
|
DP, Davis
|
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G, Aleong
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R, O’Connor
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CM, Fiuzat
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M, Carson
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PE
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|
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I, Coskun
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N, Yavuzkir
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M, Iikay
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E, Dagli
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N, Isik
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K, Gramley
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F. Catheter ablation of persistent atrial fibrillation : Beneficial effect of a short-term adjunctive amiodarone therapy on the long-term outcome. Herzschrittmachertherapie und elektrophysiologie. 2018; 29(1):133–140 [<a href="https://pubmed.ncbi.nlm.nih.gov/28447159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28447159</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>72.</dt><dd><div class="bk_ref" id="niceng196er8.ref72">Khairy
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P, Roy
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D. Atrial fibrillation: Challenging the status quo: beta-blockers for HF plus AF. Nature Reviews Cardiology. 2014; 11(12):690–692 [<a href="https://pubmed.ncbi.nlm.nih.gov/25311227" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25311227</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>73.</dt><dd><div class="bk_ref" id="niceng196er8.ref73">Khan
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SS, Gheorghiade
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M. Digoxin use in atrial fibrillation: a critical reappraisal. Lancet. 2015; 385(9985):2330–2332 [<a href="https://pubmed.ncbi.nlm.nih.gov/25749645" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25749645</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>74.</dt><dd><div class="bk_ref" id="niceng196er8.ref74">Khand
|
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AU, Chew
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PG, Douglas
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H, Jones
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J, Jan
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A, Cleland
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JG. The effect of carvedilol on B-type natriuretic peptide and cardiac function in patients with heart failure and persistent atrial fibrillation. Cardiology. 2015; 130(3):153–158 [<a href="https://pubmed.ncbi.nlm.nih.gov/25660493" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25660493</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>75.</dt><dd><div class="bk_ref" id="niceng196er8.ref75">Khand
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AU, Rankin
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AC, Kaye
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GC, Cleland
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JG. Systematic review of the management of atrial fibrillation in patients with heart failure. European Heart Journal. 2000; 21(8):614–632 [<a href="https://pubmed.ncbi.nlm.nih.gov/10731399" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10731399</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>76.</dt><dd><div class="bk_ref" id="niceng196er8.ref76">Khand
|
|
AU, Rankin
|
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AC, Martin
|
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W, Taylor
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J, Gemmell
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I, Cleland
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JG. Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure?
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|
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G, Wirtzfeld
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A, Alt
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E, Steck
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J, Saunders
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R, Hulse
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|
|
GE, Igoumenidis
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NE, Marketou
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ME, Kaleboubas
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MD, Simantirakis
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EN, Vardas
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PE. Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study. Heart. 2000; 84(3):251–257 [<a href="/pmc/articles/PMC1760955/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1760955</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10956284" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10956284</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>79.</dt><dd><div class="bk_ref" id="niceng196er8.ref79">Kochiadakis
|
|
GE, Igoumenidis
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NE, Marketou
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ME, Solomou
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MC, Kanoupakis
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EM, Vardas
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|
|
GE, Kanoupakis
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EM, Igoumenidis
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NE, Mavrakis
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HE, Kafarakis
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PK, Vardas
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PE. Efficacy and safety of oral amiodarone in controlling heart rate in patients with persistent atrial fibrillation who have undergone digitalisation. Hellenic Journal of Cardiology. 2005; 46(5):336–340 [<a href="https://pubmed.ncbi.nlm.nih.gov/16295942" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16295942</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>81.</dt><dd><div class="bk_ref" id="niceng196er8.ref81">Koh
|
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KK, Kwon
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KS, Park
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HB, Baik
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SH, Park
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SJ, Lee
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|
SM, Toufektzian
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L, Harling
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L, Bille
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|
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D, Calvert
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M, Deeks
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JJ, Griffith
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M, Kirchhof
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P, Lip
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|
|
D, Holmes
|
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J, Krum
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H, Altman
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DG, Manzano
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L, Cleland
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JG
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DA, Boos
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CJ, Lip
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GY. Atrial fibrillation (chronic). BMJ Clinical Evidence. 2015; 2015:217</div></dd></dl><dl class="bkr_refwrap"><dt>86.</dt><dd><div class="bk_ref" id="niceng196er8.ref86">Lang
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R, Klein
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HO, Weiss
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E, David
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D, Sareli
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P, Levy
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A
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|
|
P, Hulot
|
|
JS, Escolano
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S, Mallet
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A, Leizorovicz
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A, Werhlen-Grandjean
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M
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GY, Apostolakis
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S. Atrial fibrillation (acute onset). BMJ Clinical Evidence. 2014; 2014:0210 [<a href="/pmc/articles/PMC4246362/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4246362</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25430048" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25430048</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>89.</dt><dd><div class="bk_ref" id="niceng196er8.ref89">Lombardi
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F, Borggrefe
|
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M, Ruzyllo
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W, Luderitz
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B. Azimilide vs. placebo and sotalol for persistent atrial fibrillation: The A-COMET-II (Azimilide-CardiOversion MaintEnance Trial-II) trial. European Heart Journal. 2006; 27(18):2224–2231 [<a href="https://pubmed.ncbi.nlm.nih.gov/16935870" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16935870</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>90.</dt><dd><div class="bk_ref" id="niceng196er8.ref90">Lumer
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|
GB, Roy
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D, Talajic
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M, Couturier
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A, Lambert
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J, Frasure-Smith
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N
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T, Ryden
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L. Ventricular rate control and exercise performance in chronic atrial fibrillation: effects of diltiazem and verapamil. Journal of the American College of Cardiology. 1990; 16(1):86–90 [<a href="https://pubmed.ncbi.nlm.nih.gov/2358610" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2358610</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>92.</dt><dd><div class="bk_ref" id="niceng196er8.ref92">MacMahon
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SS, N;Doughty, R.
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I, Santostasi
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G, Gaion
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RM, Trento
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M, Grion
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AM, Miraglia
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Y, Cleland
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JG. Should beta-blockers be used in patients with heart failure and atrial fibrillation?
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|
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JL, deSouza
|
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IS, Silverberg
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M, Freedman
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J, Sinert
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R. Beta-blockers versus calcium channel blockers for acute rate control of atrial fibrillation with rapid ventricular response: a systematic review. European Journal of Emergency Medicine. 2015; 22(3):150–154 [<a href="https://pubmed.ncbi.nlm.nih.gov/25564459" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25564459</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>96.</dt><dd><div class="bk_ref" id="niceng196er8.ref96">McMurray
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J, Kober
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L, Robertson
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M, Dargie
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H, Colucci
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W, Lopez-Sendon
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RL, Tamariz
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LJ, Segal
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JB, Bass
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EB. Management of atrial fibrillation: review of the evidence for the role of pharmacologic therapy, electrical cardioversion, and echocardiography. Annals of Internal Medicine. 2003; 139(12):1018–1033 [<a href="https://pubmed.ncbi.nlm.nih.gov/14678922" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14678922</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>98.</dt><dd><div class="bk_ref" id="niceng196er8.ref98">MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999; 353(9169):2001–2007 [<a href="https://pubmed.ncbi.nlm.nih.gov/10376614" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10376614</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>99.</dt><dd><div class="bk_ref" id="niceng196er8.ref99">Moghadam
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MA, Dashti
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MF, Shahsavarinia
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K, Mahmoodpoor
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A, Jamali
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K. A comparison of verapamil and digoxin for heart rate control in atrial fibrillation. Advanced Pharmaceutical Bulletin. 2012; 2(2):201–205 [<a href="/pmc/articles/PMC3846001/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3846001</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24312794" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24312794</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>100.</dt><dd><div class="bk_ref" id="niceng196er8.ref100">Mooss
|
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AN, Wurdeman
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RL, Mohiuddin
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SM, Reyes
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AP, Sugimoto
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JT, Scott
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KL, Pickworth
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KK. Intravenous amiodarone for the treatment of atrial fibrillation in the nonsurgical patient. Journal of Pharmacy Practice. 2002; 15(4):356–368</div></dd></dl><dl class="bkr_refwrap"><dt>102.</dt><dd><div class="bk_ref" id="niceng196er8.ref102">Mulder
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BA, van Veldhuisen
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DJ, Crijns
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HJ, Bohm
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M, Cohen-Solal
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A, Babalis
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SL, Replogle
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WH, Dickey
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SR. Amiodarone for the treatment of persistent atrial fibrillation. Journal of Family Practice. 1999; 48(5):334–335 [<a href="https://pubmed.ncbi.nlm.nih.gov/10334605" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10334605</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>106.</dt><dd><div class="bk_ref" id="niceng196er8.ref106">Noc
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D, Horvat
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M. Intravenous amiodarone versus verapamil for acute conversion of paroxysmal atrial fibrillation to sinus rhythm. American Journal of Cardiology. 1990; 65(9):679–680 [<a href="https://pubmed.ncbi.nlm.nih.gov/2178386" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2178386</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>107.</dt><dd><div class="bk_ref" id="niceng196er8.ref107">O’Bryan
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LJ, Redfern
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OC, Bedford
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T, Young
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JD, Watkinson
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HR, Anda
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DJ. Diltiazem, verapamil, and quinidine in patients with chronic atrial fibrillation. Journal of Clinical Pharmacology. 1985; 25(3):204–209 [<a href="https://pubmed.ncbi.nlm.nih.gov/3889076" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3889076</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>109.</dt><dd><div class="bk_ref" id="niceng196er8.ref109">Packer
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M, Bristow
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MR, Cohn
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JN, Colucci
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WS, Fowler
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MB, Gilbert
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M, Coats
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AJ, Fowler
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MB, Katus
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HA, Krum
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H, Mohacsi
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J, Wang
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W, Wu
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X, Kong
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F, Pan
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J, Lin
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M, Maas
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R, Karim
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A, Muller
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HW, Simonovsky
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R, Meinertz
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T. Event-recorder monitoring in the diagnosis of atrial fibrillation in symptomatic patients: subanalysis of the SOPAT trial. Journal of Cardiovascular Electrophysiology. 2006; 17(11):1216–1220 [<a href="https://pubmed.ncbi.nlm.nih.gov/16987384" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16987384</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>113.</dt><dd><div class="bk_ref" id="niceng196er8.ref113">Peuhkurinen
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K, Niemela
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M, Ylitalo
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A, Linnaluoto
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M, Lilja
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M, Juvonen
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J. Effectiveness of amiodarone as a single oral dose for recent-onset atrial fibrillation. American Journal of Cardiology. 2000; 85(4):462–465 [<a href="https://pubmed.ncbi.nlm.nih.gov/10728951" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10728951</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>114.</dt><dd><div class="bk_ref" id="niceng196er8.ref114">Pinter
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A, Dorian
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P, Paquette
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M, Ng
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A, Burns
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M, Spanu
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EV, Michelson
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JK, Das
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G. Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter. American Journal of Cardiology. 1989; 63(13):925–929 [<a href="https://pubmed.ncbi.nlm.nih.gov/2564725" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2564725</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>116.</dt><dd><div class="bk_ref" id="niceng196er8.ref116">Plumb
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VJ, Karp
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RB, Kouchoukos
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NT, Zorn
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GL, Jr., James
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TN, Waldo
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AL. Verapamil therapy of atrial fibrillation and atrial flutter following cardiac operation. The Journal of thoracic and cardiovascular surgery. 1982; 83(4):590–596 [<a href="https://pubmed.ncbi.nlm.nih.gov/7038316" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7038316</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>117.</dt><dd><div class="bk_ref" id="niceng196er8.ref117">Pluymaekers
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N, Dudink
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E, Luermans
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J, Meeder
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JG, Lenderink
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T, Widdershoven
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W, O’Neal
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WT, Soliman
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MH. Systematic review and meta-analysis of mortality and digoxin use in atrial fibrillation. Cardiology Journal. 2016; 23(3):333–343 [<a href="https://pubmed.ncbi.nlm.nih.gov/27064796" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27064796</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>119.</dt><dd><div class="bk_ref" id="niceng196er8.ref119">Redfors
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MR, Ellis
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LG, Kasdin
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SL, Snyder
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DL, Fisher
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MB, Irvin
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M, Damman
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K, Mulder
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BA, Van Gelder
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IC, McMurray
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JJV, Van Veldhuisen
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DJ. Beta-blockers and outcome in heart failure and atrial fibrillation. A meta-analysis. JACC: Heart Failure. 2013; 1(1):21–28 [<a href="https://pubmed.ncbi.nlm.nih.gov/24621795" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24621795</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>125.</dt><dd><div class="bk_ref" id="niceng196er8.ref125">Roth
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A, Harrison
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E, Mitani
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|
|
D, Talajic
|
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M, Dorian
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P, Connolly
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S, Eisenberg
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MJ, Green
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|
|
D, Talajic
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M, Thibault
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B, Dubuc
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M, Nattel
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S, Eisenberg
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MJ
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|
|
DM, Dias
|
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VC, Kleiger
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RE, Tschida
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VH, Sung
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RJ, Sami
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F, Corino
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VD, Mainardi
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LT, Ulimoen
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SR, Enger
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S, Tveit
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P, Di Biase
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L, Burkhardt
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JD, Bai
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R, Mohanty
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P, Pump
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DM, Rivera
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AR, Tricarico
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|
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JB, McNamara
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RL, Miller
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MR, Kim
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N, Goodman
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SN, Powe
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NR
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|
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NJ, Nielsen
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EE, Safi
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S, Feinberg
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J, Gluud
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C, Jakobsen
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JC. Digoxin for atrial fibrillation and atrial flutter: A systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. PloS One. 2018; 13(3):e0193924 [<a href="/pmc/articles/PMC5843263/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5843263</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29518134" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29518134</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>134.</dt><dd><div class="bk_ref" id="niceng196er8.ref134">Sethi
|
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NJ, Safi
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S, Feinberg
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J, Nielsen
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EE, Gluud
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C, Jakobsen
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JC. Digoxin versus placebo, no intervention, or other medical interventions for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis. Systematic Reviews. 2017; 6(1):71 [<a href="/pmc/articles/PMC5382469/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5382469</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28381269" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28381269</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>135.</dt><dd><div class="bk_ref" id="niceng196er8.ref135">Shojaee
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M, Feizi
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B, Miri
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R, Etemadi
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J, Feizi
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AH. Intravenous amiodarone versus digoxin in atrial fibrillation rate control; a clinical trial. Emergency. 2017; 5(1):e29 [<a href="/pmc/articles/PMC5325898/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5325898</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28286836" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28286836</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>136.</dt><dd><div class="bk_ref" id="niceng196er8.ref136">Shu
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|
M, Xi
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R, Zhang
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P, He
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G, Song
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Z, Chi
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CS, Ghali
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WA, Sanfilippo
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AJ, Moritz
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S, Abdollah
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H. Clinical assessment of clonidine in the treatment of new-onset rapid atrial fibrillation: a prospective, randomized clinical trial. American Heart Journal. 2001; 142(2):E3 [<a href="https://pubmed.ncbi.nlm.nih.gov/11479482" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11479482</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>138.</dt><dd><div class="bk_ref" id="niceng196er8.ref138">Singh
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S, Saini
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RK, DiMarco
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J, Kluger
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J, Gold
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R, Chen
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YW. Efficacy and safety of sotalol in digitalized patients with chronic atrial fibrillation. The Sotalol Study Group. American Journal of Cardiology. 1991; 68(11):1227–1230 [<a href="https://pubmed.ncbi.nlm.nih.gov/1951086" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1951086</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>139.</dt><dd><div class="bk_ref" id="niceng196er8.ref139">Singh
|
|
SN, Singh
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BN, Reda
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DJ, Fye
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CL, Ezekowitz
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MD, Fletcher
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RD
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CW, Lau
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CP, Lee
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WL, Lam
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KF, Tse
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HF. Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation. Critical Care Medicine. 2009; 37(7):2174–2180 [<a href="https://pubmed.ncbi.nlm.nih.gov/19487941" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19487941</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>141.</dt><dd><div class="bk_ref" id="niceng196er8.ref141">Stern
|
|
EH, Pitchon
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R, King
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BD, Guerrero
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J, Schneider
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RR, Wiener
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I. Clinical use of oral verapamil in chronic and paroxysmal atrial fibrillation. Chest. 1982; 81(3):308–311 [<a href="https://pubmed.ncbi.nlm.nih.gov/7056105" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7056105</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>142.</dt><dd><div class="bk_ref" id="niceng196er8.ref142">Sticherling
|
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C, Hsu
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W, Tada
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H, Bares
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AC, Oral
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H, Pelosi
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|
|
C, Tada
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H, Hsu
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W, Bares
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AC, Oral
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H, Pelosi
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SD, Orme
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ME, Morais
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E, Mitchell
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SA. Interventions for the treatment of atrial fibrillation: a systematic literature review and meta-analysis. International Journal of Cardiology. 2013; 165(2):229–236 [<a href="https://pubmed.ncbi.nlm.nih.gov/22469557" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22469557</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>145.</dt><dd><div class="bk_ref" id="niceng196er8.ref145">Sung
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RJ, Tan
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HL, Karagounis
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L, Hanyok
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JJ, Falk
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RJ, Waxman
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HL, Elser
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AE, Moncloa
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FF, Zupkis
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RV. Antiarrhythmic effects of intravenous timolol in supraventricular arrhythmias. Clinical Pharmacology and Therapeutics. 1985; 37(2):124–127 [<a href="https://pubmed.ncbi.nlm.nih.gov/3881206" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3881206</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>148.</dt><dd><div class="bk_ref" id="niceng196er8.ref148">Thomas
|
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SP, Guy
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D, Wallace
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E, Crampton
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R, Kijvanit
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P, Eipper
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JE, Padhi
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ID, Goldberg
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AD, Silverman
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NA, Webb
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C, McDonough
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M, Talano
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JV. Atrial fibrillation and flutter. immediate control and conversion with intravenously administered verapamil. Archives of Internal Medicine. 1983; 143(5):877–881 [<a href="https://pubmed.ncbi.nlm.nih.gov/6679229" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6679229</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>151.</dt><dd><div class="bk_ref" id="niceng196er8.ref151">Tse
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HF, Lam
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YM, Lau
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CP, Cheung
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BM, Kumana
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CR. Comparison of digoxin versus low-dose amiodarone for ventricular rate control in patients with chronic atrial fibrillation. Clinical and Experimental Pharmacology and Physiology. 2001; 28(5–6):446–450 [<a href="https://pubmed.ncbi.nlm.nih.gov/11380520" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11380520</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>152.</dt><dd><div class="bk_ref" id="niceng196er8.ref152">Tse
|
|
HF, Lau
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CP, Wang
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Q, Pelosi
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F, Oral
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H, Knight
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BP
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|
|
T, Yamashita
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T, Fukunami
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M, Kumagai
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K, Niwano
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S, Okumura
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M, Erath
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JW, Benz
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AP, Lopes
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RD, Hohnloser
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SH. Meta-analysis of effects of digoxin on survival in patients with atrial fibrillation or heart failure: an update. American Journal of Cardiology. 2019; 123(1):69–74 [<a href="https://pubmed.ncbi.nlm.nih.gov/30539748" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30539748</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>155.</dt><dd><div class="bk_ref" id="niceng196er8.ref155">Vamos
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M, Erath
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JW, Hohnloser
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SH. Digoxin-associated mortality: a systematic review and meta-analysis of the literature. European Heart Journal. 2015; 36(28):1831–1838 [<a href="https://pubmed.ncbi.nlm.nih.gov/25939649" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25939649</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>156.</dt><dd><div class="bk_ref" id="niceng196er8.ref156">Veloso
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HH, de Paola
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AAV, Olshansky
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B, Rosenfeld
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LE, Warner
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AL, Solomon
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AJ. Beta-blockers versus digoxin to control ventricular rate during atrial fibrillation. Journal of the American College of Cardiology. 2005; 45(11):1905–1907 [<a href="https://pubmed.ncbi.nlm.nih.gov/15936626" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15936626</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>157.</dt><dd><div class="bk_ref" id="niceng196er8.ref157">Veloso
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HH, Joseph
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F, Bristow
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MR, Swedberg
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K, Camerini
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F, Fowler
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MB, Silver
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MA
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L, Liu
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Q, Ma
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ZQ, Zhang
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R, Chen
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MT, Wang
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|
QS, Zhang
|
|
Y, Huang
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|
XH
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et al. Digoxin is associated with increased all-cause mortality in patients with atrial fibrillation regardless of concomitant heart failure: a meta-analysis. Journal of Cardiovascular Pharmacology. 2015; 66(3):270–275 [<a href="https://pubmed.ncbi.nlm.nih.gov/26348825" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26348825</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>161.</dt><dd><div class="bk_ref" id="niceng196er8.ref161">Wanless
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RS, Anderson
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K, Joy
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M, Joseph
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SP. Multicenter comparative study of the efficacy and safety of sotalol in the prophylactic treatment of patients with paroxysmal supraventricular tachyarrhythmias. American Heart Journal. 1997; 133(4):441–446 [<a href="https://pubmed.ncbi.nlm.nih.gov/9124166" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9124166</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>162.</dt><dd><div class="bk_ref" id="niceng196er8.ref162">Wasir
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HS, Mahapatra
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RK, Bhatia
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ML, Roy
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SB, Sannerstedt
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R. Metoprolol--a new cardioselective beta-adrenoceptor blocking agent for treatment of tachyarrhythmias. British Heart Journal. 1977; 39(8):834–838 [<a href="/pmc/articles/PMC483327/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC483327</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/901674" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 901674</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>163.</dt><dd><div class="bk_ref" id="niceng196er8.ref163">Wattanasuwan
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N, Khan
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IA, Mehta
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NJ, Arora
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P, Singh
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N, Vasavada
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BC
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et al. Acute ventricular rate control in atrial fibrillation: IV combination of diltiazem and digoxin vs. IV diltiazem alone. Chest. 2001; 119(2):502–506 [<a href="https://pubmed.ncbi.nlm.nih.gov/11171729" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11171729</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>164.</dt><dd><div class="bk_ref" id="niceng196er8.ref164">Williams
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DO, Tatelbaum
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R, Most
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AS. Effective treatment of supraventricular arrhythmias with acebutolol. American Journal of Cardiology. 1979; 44(3):521–525 [<a href="https://pubmed.ncbi.nlm.nih.gov/382821" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 382821</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>165.</dt><dd><div class="bk_ref" id="niceng196er8.ref165">Xu
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T, Huang
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Y, Zhou
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H, Bai
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Y, Huang
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X, Hu
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Y
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et al. Beta-blockers and risk of all-cause mortality in patients with chronic heart failure and atrial fibrillation-a meta-analysis. BMC Cardiovascular Disorders. 2019; 19(1):135 [<a href="/pmc/articles/PMC6547467/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6547467</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31159740" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31159740</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>166.</dt><dd><div class="bk_ref" id="niceng196er8.ref166">Ziff
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OJ, Samra
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M, Howard
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JP, Bromage
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DI, Ruschitzka
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F, Francis
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DP
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et al. Beta-blocker efficacy across different cardiovascular indications: an umbrella review and meta-analytic assessment. BMC Medicine. 2020; 18(1):103 [<a href="/pmc/articles/PMC7199339/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7199339</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32366251" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32366251</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>167.</dt><dd><div class="bk_ref" id="niceng196er8.ref167">Zoble
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RG, Brewington
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J, Olukotun
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AY, Gore
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R. Comparative effects of nadolol-digoxin combination therapy and digoxin monotherapy for chronic atrial fibrillation. American Journal of Cardiology. 1987; 60(6):39D–45D [<a href="https://pubmed.ncbi.nlm.nih.gov/3307366" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3307366</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng196er8.appa"><h3>Appendix A. Review protocols</h3><p id="niceng196er8.appa.et1"><a href="/books/NBK571338/bin/niceng196er8-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 6. Review protocol: Non-ablative rate control in AF</a><span class="small"> (PDF, 216K)</span></p><p id="niceng196er8.appa.et2"><a href="/books/NBK571338/bin/niceng196er8-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 7. Health economic review protocol</a><span class="small"> (PDF, 179K)</span></p></div><div id="niceng196er8.appb"><h3>Appendix B. Literature search strategies</h3><p>This literature search strategy was used for the following reviews;
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<ul><li class="half_rhythm"><div><b>What is the clinical and cost effectiveness of different non-ablative rate control therapies in people with atrial fibrillation?</b></div></li></ul></p><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng196er8.ref103" rid="niceng196er8.ref103"><sup>103</sup></a></p><p>For more information, please see the Methods Report published as part of the accompanying documents for this guideline.</p><p id="niceng196er8.appb.et1"><a href="/books/NBK571338/bin/niceng196er8-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.1. Clinical search literature search strategy</a><span class="small"> (PDF, 305K)</span></p><p id="niceng196er8.appb.et2"><a href="/books/NBK571338/bin/niceng196er8-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.2. Health Economics literature search strategy</a><span class="small"> (PDF, 244K)</span></p></div><div id="niceng196er8.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="niceng196er8.appc.et1"><a href="/books/NBK571338/bin/niceng196er8-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 1. Flow chart of clinical study selection for the review of non-ablative rate control in AF</a><span class="small"> (PDF, 151K)</span></p></div><div id="niceng196er8.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="niceng196er8.appd.et1"><a href="/books/NBK571338/bin/niceng196er8-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (232K)</span></p></div><div id="niceng196er8.appe"><h3>Appendix E. Forest plots</h3><p id="niceng196er8.appe.et1"><a href="/books/NBK571338/bin/niceng196er8-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.1. Amiodarone vs. digoxin</a><span class="small"> (PDF, 205K)</span></p><p id="niceng196er8.appe.et2"><a href="/books/NBK571338/bin/niceng196er8-appe-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.2. Beta-blockers vs. digoxin</a><span class="small"> (PDF, 165K)</span></p></div><div id="niceng196er8.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng196er8.appf.et1"><a href="/books/NBK571338/bin/niceng196er8-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 10. Clinical evidence profile: Amiodarone vs. digoxin</a><span class="small"> (PDF, 216K)</span></p><p id="niceng196er8.appf.et2"><a href="/books/NBK571338/bin/niceng196er8-appf-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 11. Clinical evidence profile: Beta-blockers vs. digoxin</a><span class="small"> (PDF, 134K)</span></p></div><div id="niceng196er8.appg"><h3>Appendix G. Health economic evidence selection</h3><p id="niceng196er8.appg.et1"><a href="/books/NBK571338/bin/niceng196er8-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 16. Flow chart of health economic study selection for the guideline</a><span class="small"> (PDF, 256K)</span></p></div><div id="niceng196er8.apph"><h3>Appendix H. Health economic evidence tables</h3><p>None.</p></div><div id="niceng196er8.appi"><h3>Appendix I. Excluded studies</h3><p id="niceng196er8.appi.et1"><a href="/books/NBK571338/bin/niceng196er8-appi-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">I.1. Excluded clinical studies</a><span class="small"> (PDF, 216K)</span></p><p id="niceng196er8.appi.et2"><a href="/books/NBK571338/bin/niceng196er8-appi-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">I.2. Excluded health economic studies</a><span class="small"> (PDF, 122K)</span></p></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Intervention evidence review</p><p>Developed by the National Guideline Centre, Royal College of Physicians</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and, where appropriate, their carer or guardian.</p><p>Local commissioners and providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div><div class="small"><span class="label">Bookshelf ID: NBK571338</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/34165938" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">34165938</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng196er8tab1"><div id="niceng196er8.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571338/table/niceng196er8.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er8.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng196er8.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng196er8.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People aged over 18 with a diagnosis of non-valvular AF</td></tr><tr><th id="hd_b_niceng196er8.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_niceng196er8.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Rate limiting Beta-blockers</b>(e.g.*. acebutolol, metoprolol, nadolol, pindolol, propranolol, esmalol)</p><p><b>Rate limiting Ca2+ channel blockers</b> (i.e.* diltiazem hydrochloride, verapamil)</p><p><b>Digoxin</b></p><p><b>Amiodarone</b></p><p>Combinations of the above (i.e. Digoxin and Beta-blockers) drugs (licensed individually) are also included.</p><p>UK licensed doses only</p><p>Only UK licenced drugs (for any indication)</p></td></tr><tr><th id="hd_b_niceng196er8.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparisons</th><td headers="hd_b_niceng196er8.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><ul><li class="half_rhythm"><div>To each other (BETWEEN the above 4 main CLASSES OF INTERVENTION ONLY - i.e.no comparisons between different types of beta-blockers or between different types of Ca2+ channel blockers will be undertaken)</div></li><li class="half_rhythm"><div>Placebo</div></li><li class="half_rhythm"><div>Usual Care / no treatment</div></li></ul></td></tr><tr><th id="hd_b_niceng196er8.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng196er8.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Critical
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<ul><li class="half_rhythm"><div>health-related quality of life</div></li><li class="half_rhythm"><div>mortality</div></li><li class="half_rhythm"><div>hospitalisation</div></li><li class="half_rhythm"><div>HF/exacerbation of heart failure.</div></li><li class="half_rhythm"><div>Failure of non-ablative rate control</div></li></ul></td></tr><tr><th id="hd_b_niceng196er8.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng196er8.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Randomised controlled trials and SRs of RCTs</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng196er8tab2"><div id="niceng196er8.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571338/table/niceng196er8.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er8.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng196er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng196er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention and comparison</th><th id="hd_h_niceng196er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng196er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng196er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Hofmann 2006<a class="bibr" href="#niceng196er8.ref57" rid="niceng196er8.ref57"><sup>57</sup></a></p><p>RCT</p><p>N=100</p><p>Conducted in Austria</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Amiodarone:</b>450 mg IV amiodarone over 1 min followed by flush of 10 ml saline solution. If ventricular rate >100 bpm after 30 min, further IV dose of 300 mg amiodarone given</p><p><b>Digoxin:</b>0.6 mg IV digoxin within 1 min. If ventricular rate >100 bpm after 30 min, second bolus of 0.4 mg digoxin given</p><p>Rate control measured at 30 min post-initial dose</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>≥18 years old with atrial fibrillation and a mean ventricular rate >135 bpm measured in coronary care unit</p><p>12-lead ECG assessment</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Mortality (in-hospital)</p><p>Failure of non-ablative rate control</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Some with a history of coronary bypass surgery and valve replacement but less than 10%</p><p>Proportion were already taking beta-blockers (28% vs. 30%) or calcium channel blockers (12% vs. 8%) on admission</p></td></tr><tr><td headers="hd_h_niceng196er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Khand 2003 and 2015<a class="bibr" href="#niceng196er8.ref74" rid="niceng196er8.ref74"><sup>74</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er8.ref76" rid="niceng196er8.ref76"><sup>76</sup></a></p><p>RCT</p><p>N=47</p><p>Conducted in UK</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Study consisted of two phases for each of the two interventions.</p><p><b>Rate limiting beta-blockers – carvedilol:</b></p><p><b>Phase I:</b>Open-label digoxin use prior to study continued + double-blind carvedilol randomly assigned at starting dose of 3.125 mg b.i.d. Dose increased at 2-week intervals until target dose of 25 mg b.i.d reached (2-month up titration period). Phase I lasted 4 months.</p><p><b>Phase II:</b> Open-label digoxin in phase I replaced with double-blind placebo + double-blind carvedilol use in phase I continued. Phase II lasted for duration of 2 months.</p><p><b>Digoxin:</b></p><p><b>Phase I:</b> Open-label digoxin use prior to study continued + double-blind placebo randomly assigned instead of carvedilol. Phase I lasted 4 months.</p><p><b>Phase II:</b> Open-label digoxin in phase I replaced with double-blind digoxin + double-blind placebo use in phase I continued. Phase II lasted for duration of 2 months.</p><p>Outcomes measured at 6 months post-randomisation (end of trial)</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Patients with persistent AF (>1 month) and heart failure (appropriate symptoms for > 2 months and ECG evidence of cardiac dysfunction) that were receiving digoxin and diuretics</p><p>Setting unclear – e.g. outpatients/secondary care</p><p>12-lead ECG assessment</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Mortality</p><p>Heart failure onset or exacerbation</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Complex study design consisting of two phases was performed as withdrawal of digoxin at the same time as initiating and uptitrating beta-blockers could increase the risk of worsening HF. This design allowed the double-blinded initiation of carvedilol first, followed by double-blinded withdrawal of digoxin once maintenance doses of carvedilol had been achieved.</p><p>At baseline proportion were using ACE inhibitors (71% vs. 71%) and/or anticoagulation (79% vs. 83%)</p></td></tr><tr><td headers="hd_h_niceng196er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Shojaee 2017<a class="bibr" href="#niceng196er8.ref135" rid="niceng196er8.ref135"><sup>135</sup></a></p><p>RCT</p><p>N=84</p><p>Conducted in Iran</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Amiodarone:</b> 150 mg IV amiodarone in 5% dextrose infused over 10 min. If no improvement, another 150 mg dose infused and all patients received maintenance dose of 50 mg/h during first 3 hours of treatment.</p><p><b>Digoxin:</b> 1 mg IV digoxin infused with initial injection of 0.5 mg followed by two 0.25 mg doses in second and fourth hour after intervention.</p><p>Followed up for at least 12 hours post-first dose</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Patients between 18 and 80 years old presenting to emergency department with atrial fibrillation with rapid ventricular rate and relative contraindication for first line drugs (calcium channel blockers and beta-blockers)</p><p>12-lead ECG assessment</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Failure of non-ablative rate control</td><td headers="hd_h_niceng196er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Valve disease not an exclusion criterion but no mention of any concomitant valve disease</p><p>Amiodarone used a half the dose needed for rhythm conversion as using with the aim of rate control rather than rhythm control</p></td></tr><tr><td headers="hd_h_niceng196er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Siu 2009<a class="bibr" href="#niceng196er8.ref140" rid="niceng196er8.ref140"><sup>140</sup></a></p><p>RCT</p><p>N=150</p><p>Conducted in Hong Kong (China)</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Amiodarone:</b> Loading infusion of 300 mg IV amiodarone over first hour followed by 10 mg/kg over 24 h</p><p><b>Digoxin:</b> Initial bolus of 0.5 mg IV digoxin followed by 0.25 mg every 8 h (1.25 mg over 24 h).</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Patients presenting to emergency department with symptomatic acute AF and rapid ventricular rate (>120 bpm) requiring hospitalisation</p><p>ECG assessment method</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Heart failure onset or exacerbation</p><p>Failure of non-ablative rate control</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Valve disease not an exclusion criterion but no mention of any concomitant valve disease</p><p>Dose used for amiodarone was lower than maximum recommended dose for pharmacological conversion as aim of the study was to control rate not rhythm.</p></td></tr><tr><td headers="hd_h_niceng196er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Tse 2001<a class="bibr" href="#niceng196er8.ref151" rid="niceng196er8.ref151"><sup>151</sup></a></p><p>RCT</p><p>N=16</p><p>Conducted in Hong Kong (China)</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Amiodarone:</b>600 mg daily for 1 week as loading dose followed by 100 mg daily for remaining 23 weeks</p><p><b>Digoxin:</b> 0.25 mg daily for 24 weeks. Lower dose used if body weight <50 kg or serum creatinine >200 mmol/L</p><p>Outcomes measured at 24 weeks (end of treatment)</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Patients with chronic AF. Setting unclear –outpatients?</p><p>12-lead ECG assessment and Holter monitoring</p></td><td headers="hd_h_niceng196er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Health-related quality of life</td><td headers="hd_h_niceng196er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>All had failed a previous attempt at restoring and maintaining sinus rhythm</p><p>All antiarrhythmic drugs discontinued for at least 2 weeks prior to beginning of study</p><p>All patients received anticoagulation therapy with warfarin for prevention of thromboembolism</p></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng196er8tab3"><div id="niceng196er8.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: Amiodarone vs. digoxin</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571338/table/niceng196er8.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er8.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er8.tab3_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er8.tab3_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er8.tab3_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er8.tab3_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er8.tab3_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er8.tab3_1_1_1_5" id="hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with digoxin</th><th headers="hd_h_niceng196er8.tab3_1_1_1_5" id="hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Amiodarone (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>SF-36 physical functioning domain (24 weeks)</p><p>Scale from: 0 to 100.</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>15</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 physical functioning domain (24 weeks) in the control groups was</p><p>78</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 physical functioning domain (24 weeks) in the intervention groups was</p><p>14 higher</p><p>(0.27 to 27.73 higher)</p><p>Note: MID was deemed to be 8(based on 0.5 × median sd [16.0] in digoxin group)</p></td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>SF-36 physical role functioning domain (24 weeks)</p><p>Scale from: 0 to 100.</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>15</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>c</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 physical role functioning domain (24 weeks) in the control groups was</p><p>92</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 physical role functioning domain (24 weeks) in the intervention groups was</p><p>9 lower</p><p>(34.83 lower to 16.83 higher)</p><p>Note: MID was deemed to be 6(based on 0.5 × median sd [12.0] in digoxin group)</p></td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>SF-36 bodily pain domain (24 weeks)</p><p>Scale from: 0 to 100.</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>15</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>d</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 bodily pain domain (24 weeks) in the control groups was</p><p>77</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 bodily pain domain (24 weeks) in the intervention groups was</p><p>6 lower</p><p>(34.18 lower to 22.18 higher)</p><p>Note: MID was deemed to be 15(based on 0.5 × median sd [30.0] in digoxin group)</p></td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>SF-36 general health domain (24 weeks)</p><p>Scale from: 0 to 100.</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>15</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>e</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 general health domain (24 weeks) in the control groups was</p><p>57</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 general health domain (24 weeks) in the intervention groups was</p><p>1 higher</p><p>(19.95 lower to 21.95 higher)</p><p>Note: MID was deemed to be 11(based on 0.5 × median sd [22.0] in digoxin group)</p></td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>SF-36 vitality domain (24 weeks)</p><p>Scale from: 0 to 100.</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>15</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>f</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 vitality domain (24 weeks) in the control groups was</p><p>58</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 vitality domain (24 weeks) in the intervention groups was</p><p>9 higher</p><p>(12.76 lower to 30.76 higher)</p><p>Note: MID was deemed to be 10(based on 0.5 × median sd [20.0] in digoxin group)</p></td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>SF-36 social functioning domain (24 weeks)</p><p>Scale from: 0 to 100.</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>15</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 social functioning domain (24 weeks) in the control groups was</p><p>84</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 social functioning domain (24 weeks) in the intervention groups was</p><p>6 higher</p><p>(7.73 lower to 19.73 higher)</p><p>Note: MID was deemed to be 8(based on 0.5 × median sd [16.0] in digoxin group)</p></td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>SF-36 emotional role functioning domain (24 weeks)</p><p>Scale from: 0 to 100.</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>15</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>g</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 emotional role functioning domain (24 weeks) in the control groups was</p><p>86</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 emotional role functioning domain (24 weeks) in the intervention groups was</p><p>5 lower</p><p>(35.43 lower to 25.43 higher)</p><p>Note: MID was deemed to be 13(based on 0.5 × median sd [26.0] in digoxin group)</p></td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>SF-36 mental health domain (24 weeks)</p><p>Scale from: 0 to 100.</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>15</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>h</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 mental health domain (24 weeks) in the control groups was</p><p>58</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean sf-36 mental health domain (24 weeks) in the intervention groups was</p><p>10 higher</p><p>(15.31 lower to 35.31 higher)</p><p>Note: MID was deemed to be 11.5(based on 0.5 × median sd [23.0] in digoxin group)</p></td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality (in-hospital)</td><td headers="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>100</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>i</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.5 (0.05 to 5.34)</td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1 hd_h_niceng196er8.tab3_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40 per 1000</td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>20 fewer per 1000</p><p>(from 38 fewer to 174 more)</p></td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Heart failure onset or exacerbation (new-onset congestive heart failure)</td><td headers="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>100</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>k</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RD 0 (−0.04 to 0.04)</td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1 hd_h_niceng196er8.tab3_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>0 fewer per 1000</p><p>(from 40 fewer to 40 more)<sup>j</sup></p></td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Failure of non-ablative rate control</td><td headers="hd_h_niceng196er8.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>284</p><p>(3 studies)</p><p>0.5-24 hours</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>i</sup><sup>,</sup><sup>l</sup></p><p>due to risk of bias, inconsistency, imprecision</p></td><td headers="hd_h_niceng196er8.tab3_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.64 (0.39to 1.04)</td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1 hd_h_niceng196er8.tab3_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">595 per 1000</td><td headers="hd_h_niceng196er8.tab3_1_1_1_5 hd_h_niceng196er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>214 fewer per 1000</p><p>(from 363fewer to 24 more)</p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er8.tab3_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er8.tab3_2"><p class="no_margin">Downgraded by 1 increment as the confidence intervals crossed the upper MID of 8</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er8.tab3_3"><p class="no_margin">Downgraded by 2incrementsas the confidence intervals crossed the upper and lower MIDs of 6 and −6</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er8.tab3_4"><p class="no_margin">Downgraded by 2incrementsas the confidence intervals crossed the upper and lower MIDs of 15 and −15</p></div></dd></dl><dl class="bkr_refwrap"><dt>e</dt><dd><div id="niceng196er8.tab3_5"><p class="no_margin">Downgraded by 2incrementsas the confidence intervals crossed the upper and lower MIDs of 11 and −11</p></div></dd></dl><dl class="bkr_refwrap"><dt>f</dt><dd><div id="niceng196er8.tab3_6"><p class="no_margin">Downgraded by 2incrementsas the confidence intervals crossed the upper and lower MIDs of 10 and −10</p></div></dd></dl><dl class="bkr_refwrap"><dt>g</dt><dd><div id="niceng196er8.tab3_7"><p class="no_margin">Downgraded by 2incrementsas the confidence intervals crossed the upper and lower MIDs of 13 and −13</p></div></dd></dl><dl class="bkr_refwrap"><dt>h</dt><dd><div id="niceng196er8.tab3_8"><p class="no_margin">Downgraded by 2incrementsas the confidence intervals crossed the upper and lower MIDs of 11.5 and −11.5</p></div></dd></dl><dl class="bkr_refwrap"><dt>i</dt><dd><div id="niceng196er8.tab3_9"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>j</dt><dd><div id="niceng196er8.tab3_10"><p class="no_margin">Absolute effect calculated manually using risk difference as zero events in both arms</p></div></dd></dl><dl class="bkr_refwrap"><dt>k</dt><dd><div id="niceng196er8.tab3_11"><p class="no_margin">Serious imprecision as sample size >70 and <350</p></div></dd></dl><dl class="bkr_refwrap"><dt>l</dt><dd><div id="niceng196er8.tab3_12"><p class="no_margin">Serious inconsistency as I2 >50% and some variation in point estimates on Forest plot. Switched to random effects and rated down for inconsistency.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er8tab4"><div id="niceng196er8.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: Beta-blockers vs. digoxin</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571338/table/niceng196er8.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er8.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er8.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er8.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er8.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er8.tab4_1_1_1_2" style="text-align:left;vertical-align:bottom;"><p>No of Participants (studies)</p><p>Follow up</p></th><th id="hd_h_niceng196er8.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er8.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er8.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er8.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er8.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er8.tab4_1_1_1_5" id="hd_h_niceng196er8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with digoxin</th><th headers="hd_h_niceng196er8.tab4_1_1_1_5" id="hd_h_niceng196er8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Beta-blockers (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er8.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality (phase I - carvedilol + digoxin vs. placebo + digoxin)</td><td headers="hd_h_niceng196er8.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>43</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></p><p>due to risk of bias, indirectness, imprecision</p></td><td headers="hd_h_niceng196er8.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.05 (0.07 to 15.69)</td><td headers="hd_h_niceng196er8.tab4_1_1_1_5 hd_h_niceng196er8.tab4_1_1_2_1 hd_h_niceng196er8.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er8.tab4_1_1_1_5 hd_h_niceng196er8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46 per 1000</td><td headers="hd_h_niceng196er8.tab4_1_1_1_5 hd_h_niceng196er8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>2 more per 1000</p><p>(from 43 fewer to 676 more)</p></td></tr><tr><td headers="hd_h_niceng196er8.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality (phase II - carvedilol + placebo vs. placebo + digoxin)</td><td headers="hd_h_niceng196er8.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>37</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>c</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Peto OR 8.82 (0.17 to 450.05)</td><td headers="hd_h_niceng196er8.tab4_1_1_1_5 hd_h_niceng196er8.tab4_1_1_2_1 hd_h_niceng196er8.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er8.tab4_1_1_1_5 hd_h_niceng196er8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng196er8.tab4_1_1_1_5 hd_h_niceng196er8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>60 more per 1000</p><p>(from 80 fewer to 200 more)<sup>d</sup></p></td></tr><tr><td headers="hd_h_niceng196er8.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Heart failure onset or exacerbation (worsening heart failure symptoms during phase II - carvedilol + placebo vs. placebo + digoxin)</td><td headers="hd_h_niceng196er8.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>40</p><p>(1 study)</p></td><td headers="hd_h_niceng196er8.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>c</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er8.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 3.32 (0.38 to 29.23)</td><td headers="hd_h_niceng196er8.tab4_1_1_1_5 hd_h_niceng196er8.tab4_1_1_2_1 hd_h_niceng196er8.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er8.tab4_1_1_1_5 hd_h_niceng196er8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48 per 1000</td><td headers="hd_h_niceng196er8.tab4_1_1_1_5 hd_h_niceng196er8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>111 more per 1000</p><p>(from 30 fewer to 1000 more)</p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er8.tab4_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er8.tab4_2"><p class="no_margin">Indirectness for the intervention as during phase I of this study patients receiving carvedilol + digoxin or placebo + digoxin rather than carvedilol or digoxin only, which was initiated in phase II of the study.</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er8.tab4_3"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er8.tab4_4"><p class="no_margin">Absolute effect calculated manually from risk difference as zero events in one arm of the only included study</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er8tab5"><div id="niceng196er8.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Drug unit costs</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571338/table/niceng196er8.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er8.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Class</th><th id="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Drug (preparation)</th><th id="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dose range</th><th id="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost range per day</th><th id="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost range per year</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_1" rowspan="7" colspan="1" style="text-align:left;vertical-align:top;">Class II (beta-blockers)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Acebutolol (tablet)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.4g to 1.2 g daily in 2–3 divided doses.</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.67 to £2</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£242.73 to £728.18</td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atenolol (tablet)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50mg to 100mg daily</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.02 to £0.05</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£8.21 to £16.43</td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bisoprolol fumarate(tablet)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5mg to 10mg od</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.02 to £0.04</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£7.69 to £15.38</td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Esmolol hydrochloride(IV)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50–200 micrograms/kg/minute<sup>(a)</sup></td><td headers="hd_h_niceng196er8.tab5_1_1_1_4 hd_h_niceng196er8.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Cost per infusion bag: £89.69 <sup>(b)</sup></td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Metoprolol tartare(tablet)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50 mg bd to 300mg daily.</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06 to £0.10</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£20.08 to £34.81</td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nadolol (tablet)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">160mg od</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.43</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£156.43</td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Propranolol (tablet)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10–40 mg 3–4 times a day</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.13 to £0.14</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£49.01 to £52.40</td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Class III (K+ channel blocker)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Amiodarone(tablet)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">200mg od</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.12</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£42.50</td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Amiodarone(IV infusion)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Maximum 1.2 g per day</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£5.87</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Class IV (calcium channel blocker)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diltiazem hydrochloride</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">120mg to 360mg daily</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.13 to £0.38</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£46.60to £139.81</td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Class IV (calcium channel blocker)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Verapamil hydrochloride(tablet)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40mg to 120 mg tid</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06 to £0.14</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£20.34 to £52.40</td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Class IV (calcium channel blocker)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Verapamil hydrochloride(slow IV injection)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5–10 mg to be given over 2 minutes</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2.16 to £4.33</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr><tr><td headers="hd_h_niceng196er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Class V (Positive ionotropic drug)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Digoxin(tablet)</td><td headers="hd_h_niceng196er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">125–250 micrograms daily</td><td headers="hd_h_niceng196er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06 to £0.11</td><td headers="hd_h_niceng196er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£20.34 to £40.67</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng196er8.tab5_1"><p class="no_margin">BNF dose states: 50–200 micrograms/kg/minute, consult product literature for details of dose titration and doses during peri-operative period. Topic advisor noted that it would be used (rarely) to control rate in an emergency pending definitive treatment. In this scenario costing a 2.5g/250ml infusion bag would adequately reflect current practice. This would provide 4-6 hours of infusion depending on weight.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng196er8.tab5_2"><p class="no_margin">Brevibloc premixed 2.5mg/250ml infusion bags</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source of cost and dose: BNF<a class="bibr" href="#niceng196er8.ref15" rid="niceng196er8.ref15"><sup>15</sup></a>, last accessed January 2020. With exception of diltiazem hydrochloride as this is an unlicensed indication. Dose based on Topic advisor clinical experience.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Abbreviations: bd: twice daily; IV: intravenous; N/A: not applicable; od: once daily; tid: three times daily.</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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