Abstract
Objective
The objective of this study was to examine the effects of metoprolol versus diltiazem
in the acute management of atrial fibrillation (AF) with rapid ventricular response
(RVR) in patients with heart failure with reduced ejection fraction (HFrEF).
Methods
This retrospective cohort study of patients with HFrEF in AF with RVR receiving either
intravenous push (IVP) doses of metoprolol or diltiazem was conducted between January
2012 and September 2016. The primary outcome was successful rate control within 30 min
of medication administration, defined as a heart rate (HR) < 100 beats per minute
or a HR reduction ≥ 20%. Secondary outcomes included rate control at 60 min, maximum
median change in HR, and incidence of hypotension, bradycardia, or conversion to normal
sinus rhythm within 30 min. Signs of worsening heart failure were also evaluated.
Results
Of the 48 patients included, 14 received metoprolol and 34 received diltiazem. The
primary outcome, successful rate control within 30 min, occurred in 62% of the metoprolol
group and 50% of the diltiazem group (p = 0.49). There was no difference in HR control at predefined time points or incidence
of hypotension, bradycardia, or conversion. Although baseline HR varied between groups,
maximum median change in HR did not differ. Signs of worsening heart failure were
similar between groups.
Conclusions
For the acute management of AF with RVR in patients with HFrEF, IVP diltiazem achieved
similar rate control with no increase in adverse events when compared to IVP metoprolol.
Keywords
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Article Info
Publication History
Published online: April 27, 2018
Accepted:
April 27,
2018
Received in revised form:
March 29,
2018
Received:
February 11,
2018
Footnotes
☆Sources of support: None.
☆☆Conflict of interest: No listed authors have any conflict of interest to the subject matter in this manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
