Intravenous diltiazem for the treatment of patients with atrial fibrillation or flutter and moderate to severe congestive heart failure

Atrial Fibrillation: A Review of the Management in the Emergency Department

“…In a separate study, IV diltiazem was shown to be effective in the treatment of AF in patients with moderate to severe CHF. 6 In this study, hypotension occurred in 11% of patients. Diltiazem has been shown to be superior to digoxin in slowing ventricular rates, 7,8 but there have been no direct comparison studies with verapamil.…”

Why are calcium antagonists still being used in heart failure in the era of calcium sensitizers?

“…This has led to the use of intravenous diltiazem as an alternative form of treatment. In the small number of cases studied, the drug has been shown to cause a rapid and efficient reduction in ventricular response in the absence of additional deterioration of ventricular function 41,42 . It is not known, however, what would be the intermediateor long-term effects of this drug.…”

Part 6: Advanced Cardiovascular Life Support : Section 5: Pharmacology I: Agents for Arrhythmias

“…IV verapamil, 135-143 ␤-blockers, 144 -150 and diltiazem [151][152][153][154][155][156][157] are recommended for rate control in patients with AF or atrial flutter, preserved LV function, and a heart rate Ն120 bpm. 136 Available evidence suggests that digitalis, 158 though effective, is the least potent and has the slowest onset of action of the available pharmacological options for ventricular rate control.…”

“…This risk may be less with diltiazem than with verapamil or ␤-blockers. 154,159 Digoxin remains the only parenteral AV nodal blocking drug with positive inotropic properties, but its usefulness is limited by its relative impotence and slow onset of action, particularly in high adrenergic states such as congestive heart failure.…”