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Comparison of sustained rate control in atrial fibrillation with rapid ventricular rate: Metoprolol vs. Diltiazem

  • Kristi L. Hargrove
    Correspondence
    Corresponding author at: Department of Pharmacotherapy and Pharmacy Services, University Health, 4502 Medical Drive, San Antonio, TX 78229, United States.
    Affiliations
    University Health, San Antonio, TX 78229, United States

    University of Texas Health San Antonio, Pharmacotherapy Education & Research Center, San Antonio, TX 78229, United States

    The University of Texas at Austin, College of Pharmacy, Austin, TX 78712, United States

    University of the Incarnate Word, Feik School of Pharmacy, San Antonio, TX 78209, United States
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  • Ellen E. Robinson
    Affiliations
    University Health, San Antonio, TX 78229, United States

    University of Texas Health San Antonio, Pharmacotherapy Education & Research Center, San Antonio, TX 78229, United States

    The University of Texas at Austin, College of Pharmacy, Austin, TX 78712, United States

    University of the Incarnate Word, Feik School of Pharmacy, San Antonio, TX 78209, United States
    Search for articles by this author
  • Kathleen A. Lusk
    Affiliations
    University Health, San Antonio, TX 78229, United States

    University of Texas Health San Antonio, Pharmacotherapy Education & Research Center, San Antonio, TX 78229, United States

    University of the Incarnate Word, Feik School of Pharmacy, San Antonio, TX 78209, United States
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  • Darrel W. Hughes
    Affiliations
    University Health, San Antonio, TX 78229, United States

    University of Texas Health San Antonio, Pharmacotherapy Education & Research Center, San Antonio, TX 78229, United States

    The University of Texas at Austin, College of Pharmacy, Austin, TX 78712, United States
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  • Luke A. Neff
    Affiliations
    University Health, San Antonio, TX 78229, United States

    University of Texas Health San Antonio, Pharmacotherapy Education & Research Center, San Antonio, TX 78229, United States

    The University of Texas at Austin, College of Pharmacy, Austin, TX 78712, United States

    University of the Incarnate Word, Feik School of Pharmacy, San Antonio, TX 78209, United States
    Search for articles by this author
  • Amanda L. Fowler
    Affiliations
    University Health, San Antonio, TX 78229, United States

    University of Texas Health San Antonio, Pharmacotherapy Education & Research Center, San Antonio, TX 78229, United States

    The University of Texas at Austin, College of Pharmacy, Austin, TX 78712, United States

    University of the Incarnate Word, Feik School of Pharmacy, San Antonio, TX 78209, United States
    Search for articles by this author
Published:December 03, 2020DOI:https://doi.org/10.1016/j.ajem.2020.11.073

      Abstract

      Objective

      The objective of this study was to compare sustained rate control with intravenous (IV) diltiazem vs. IV metoprolol in acute treatment of atrial fibrillation (AF) with rapid ventricular rate (RVR) in the emergency department (ED).

      Methods

      This retrospective chart review at a large, academic medical center identified patients with AF with RVR diagnosis who received IV diltiazem or IV metoprolol in the ED. The primary outcome was sustained rate control defined as heart rate (HR) < 100 beats per minute without need for rescue IV medication for 3 h following initial rate control attainment. Secondary outcomes included time to initial rate control, HR at initial control and 3 h, time to oral dose, admission rates, and safety outcomes.

      Results

      Between January 1, 2016 and November 1, 2018, 51 patients met inclusion criteria (diltiazem n = 32, metoprolol n = 19). No difference in sustained rate control was found (diltiazem 87.5% vs. metoprolol 78.9%, p = 0.45). Time to rate control was significantly shorter with diltiazem compared to metoprolol (15 min vs. 30 min, respectively, p = 0.04). Neither hypotension nor bradycardia were significantly different between groups.

      Conclusions

      Choice of rate control agent for acute management of AF with RVR did not significantly influence sustained rate control success. Safety outcomes did not differ between treatment groups.

      Keywords

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