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Randomized Controlled Trial
. 2025 Mar 14;25(1):181.
doi: 10.1186/s12872-025-04574-2.

Effects of diltiazem and metoprolol on levels of high-sensitivity troponin I in patients with permanent atrial fibrillation: a randomized trial

Katrine Enge  1   2 , Sara Reinvik Ulimoen  1 , Steve Enger  1 , Sophia Onarheim  1 , Mona Olufsen  1 , Are Hugo Pripp  3 , Trude Steinsvik  4 , Christian Hall  2   5 , Mathias Hetland  6 , Arnljot Tveit  7   8
Affiliations
Randomized Controlled Trial

Effects of diltiazem and metoprolol on levels of high-sensitivity troponin I in patients with permanent atrial fibrillation: a randomized trial

Katrine Enge et al. BMC Cardiovasc Disord. .

Abstract

Background: High-sensitive (hs-) cardiac troponin assays provide prognostic information in atrial fibrillation (AF) patients. Few studies have explored the impact of long-term rate control therapy on levels of troponin in AF patients without coronary heart disease and heart failure. This substudy of the RATe control in Atrial Fibrillation (RATAF) II study aimed to compare the effects of six months' treatment with diltiazem and metoprolol on hs-troponin I (TnI) levels both at rest and during exercise testing in patients with permanent AF.

Methods: This was a parallel-group, randomized, investigator-blinded clinical trial. The cohort consisted of 93 patients (28 women, mean age 71 ± 7 years) with symptomatic, permanent AF with preserved left ventricular systolic function and no coronary heart disease. Participants were randomized in a 1:1 ratio to receive either diltiazem 360 mg (n = 49) or metoprolol 100 mg (n = 44) once daily for six months. Blood tests were drawn at rest and during peak exercise testing at baseline, one month and six months' treatment. This research has been supported by grants from the South-Eastern Norway Regional Health Authority and Vestre Viken Hospital Trust.

Results: Six months' treatment with diltiazem and metoprolol significantly lowered the heart rate at rest and peak exercise. Both treatment groups exhibited a decrease in hs-TnI levels at rest (diltiazem p = 0.008, metoprolol p = 0.03) and peak exercise (diltiazem p < 0.001, metoprolol p = 0.004) at six months compared to baseline levels, with no significant differences observed between the groups.

Conclusions: In patients with permanent AF, six months of rate control therapy with diltiazem or metoprolol lowered levels of hs-TnI. Further research is warranted to determine whether this reduction translates into an improved prognosis.

Trial registration: NCT02695992. Registration date: 2015-04-28.

Keywords: Atrial fibrillation; Beta-blockers; Biomarkers; Calcium channel blockers; Cardiac troponins; Rate control.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The RATAF II trial was approved by the Norwegian Medicines Agency and the Regional Ethics Committee (2015/1302). The trial was registered at www.clinicaltrials.gov (NCT02695992). Each patient gave informed consent in agreement with the Helsinki Declaration before participating in any study-related activity. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the randomized patients. The number of patients with blood samples available for hs-TnI analyses are presented in parentheses
Fig. 2
Fig. 2
Boxplot of levels of hs-TnI at rest and peak exercise at baseline, one month and six months. Median levels of hs-TnI (ng/L) at rest (dark bars) and peak exercise (light bars) at baseline and follow-up visits at one month and six months. Centre lines show the medians, box limits depict 25th and 75th percentiles. Whiskers encompass 1.5 times the interquartile range from the 25th and 75th percentile
See this image and copyright information in PMC

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