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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Article Info
Publication History
Published online: December 03, 2020
Accepted:
November 29,
2020
Received in revised form:
November 28,
2020
Received:
July 28,
2020
Footnotes
☆All authors approved the final manuscript as submitted.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
