Comparing Two Heart Medicines for Fast, Irregular Heartbeat (Atrial Fibrillation)

NCT07706075 | Not Yet Recruiting Phase 4

• 1 other identifier: POFH/05-2026/ E. Medicine/ 10
• Study Type: interventional
• Target: 120
• Locations: 0 countries
• Sites: N/A

Brief Summary

The goal of this clinical trial is to learn whether intravenous verapamil or intravenous metoprolol controls heart rate more effectively in adult patients who arrive at the emergency department with atrial fibrillation and a fast heart rate (rapid ventricular response), but who are otherwise medically stable. Atrial fibrillation with a rapid heart rate is a common emergency, and doctors currently choose between these two standard medicines based on personal preference rather than strong local evidence, since there is limited research on this comparison in Pakistani patients. The main questions this study aims to answer are: Does a higher proportion of patients reach a target heart rate of less than 110 beats per minute within 30 minutes with verapamil compared to metoprolol? Which medicine controls the heart rate faster, on average? Are there differences in side effects (such as low blood pressure, slow heart rate, or breathing problems) between the two medicines? Researchers will compare a group of patients receiving verapamil to a group receiving metoprolol to see if one medicine controls the heart rate faster and more safely than the other. Participants will:

1. 1.Receive either verapamil or metoprolol through an IV, with the dose given according to standard protocols
2. 2.Have their heart rate, blood pressure, and oxygen levels monitored continuously for 30 minutes after the medicine is given
3. 3.Be observed for any side effects during this monitoring period Both medicines used in this study are already standard, guideline-recommended treatments for this condition, so participation will not change or delay the medical care patients would normally receive.

Conditions

Atrial Fibrillation (AF); Atrial Fibrillation With Rapid Ventricular Response

Keywords

atrial fibrillation; Rapid ventricular Response; Rate Control; Verapamil; Metoprolol; Calcium Channel Blockers; Beta Blockers; Cardiac Arrythmia; Hemodynamically unstable

Outcome Measures

Primary Outcomes (1)

• Proportion of Participants Achieving Target Heart Rate Control Within 30 Minutes

  Percentage of participants in each treatment group achieving a ventricular rate of less than 110 beats per minute, as measured by continuous cardiac monitoring, within 30 minutes of study drug administration.

  30 minutes after study drug administration

Secondary Outcomes (2)

• Time to Achievement of Target Heart Rate

  Measured continuously from time 0 up to 30 minutes post-drug administration

• Number of Participants with Adverse Drug Events

  From study drug administration up to 30 minutes

Study Arms (2)

Verapamil group

ACTIVE COMPARATOR

Participants received intravenous verapamil, initial dose 5 mg over 2 minutes; if target heart rate (\<110 bpm) not achieved within 15 minutes, an additional 5 mg IV dose given, to a cumulative maximum of 10 mg.

Drug: Verapamil Hydrochloride

Metoprolol group

ACTIVE COMPARATOR

Participants received intravenous metoprolol tartrate, initial dose 5 mg over 2 minutes; if target heart rate (\<110 bpm) not achieved within 5 minutes, up to two additional 5 mg IV doses given at 5-minute intervals, to a cumulative maximum of 15 mg.

Drug: Metoprolol tartrate

Interventions

Verapamil Hydrochloride DRUG

Intravenous verapamil administered as an initial 5 mg dose over 2 minutes, with an additional 5 mg dose permitted after 15 minutes if target heart rate not achieved, up to a cumulative maximum of 10 mg.

Verapamil group

Metoprolol tartrate DRUG

Intravenous metoprolol tartrate administered as an initial 5 mg dose over 2 minutes, with up to two additional 5 mg doses at 5-minute intervals if target heart rate not achieved, up to a cumulative maximum of 15 mg.

Metoprolol group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult patients aged 18 years and above presenting to the Emergency Department
• Confirmed diagnosis of atrial fibrillation with rapid ventricular response (heart rate ≥110 bpm) on 12-lead ECG
• Hemodynamically stable at the time of enrollment (systolic blood pressure ≥90 mmHg, no shock, no acute pulmonary edema)
• Willingness to provide written informed consent

You may not qualify if:

• Hemodynamic instability, cardiogenic shock, or acute decompensated heart failure
• Known pre-excitation syndrome (e.g., Wolff-Parkinson-White syndrome) on baseline ECG
• Severe left ventricular systolic dysfunction (ejection fraction less than 30%) as determined by echocardiography
• Known hypersensitivity or contraindication to verapamil or metoprolol
• Patients already taking rate control agents (beta-blockers, calcium channel blockers, or digoxin) in the last 24 hours
• Major bradycardia (heart rate less than 50 bpm) or AV block (second or third degree) on baseline ECG
• Active bronchospasm or severe obstruction of pulmonary disease
• Severe hepatic impairment (Child-Pugh Class C) or acute renal failure (eGFR \<15 mL/min/1.73 m²)
• Pregnancy or breastfeeding
• Inability to give informed consent

Sponsors & Collaborators

• Muhammad Ali Javed: lead

MeSH Terms

Conditions

Atrial Fibrillation

Interventions

Verapamil; Metoprolol

Condition Hierarchy (Ancestors)

Arrhythmias, Cardiac; Heart Diseases; Cardiovascular Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Phenethylamines; Ethylamines; Amines; Organic Chemicals; Phenoxypropanolamines; Propanolamines; Amino Alcohols; Alcohols; Propanols

Central Study Contacts

Muhammad Ali Javed, MBBS

CONTACT

+923295718202; ajaved123886@gmail.com

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The research officer responsible for recording adverse events, clinical outcomes, and the need for rescue medication was blinded to treatment allocation during data collection.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Clinical Professor

Model Details: Eligible patients with hemodynamically stable atrial fibrillation with rapid ventricular response will be randomized 1:1 to receive either intravenous verapamil or intravenous metoprolol. Each participant receives only one intervention throughout the 30-minute observation period.

Study Record Dates

• First Submitted: July 10, 2026
• First Posted: July 15, 2026
• Study Start (Estimated): January 1, 2027
• Primary Completion (Estimated): July 1, 2027
• Study Completion (Estimated): August 1, 2027
• Last Updated: August 3, 2026

Record last verified: 2026-07