Intravenous Metoprolol Versus Diltiazem for Rate Control in Noncardiac, Nonthoracic Postoperative Atrial Fibrillation

Abstract

In NCNT surgery, patients with POAF, IV diltiazem more effectively controlled HR and hemodynamics compared with metoprolol. Results warrant further research into optimal medical management of POAF in this population using these 2 agents.

β-Blockers versus calcium channel blockers for acute rate control of atrial fibrillation with rapid ventricular response

“…In the postoperative setting, diltiazem has been shown to be more effective than metoprolol in achieving rate control after nonthoracic surgery [14]. Our systematic review suggests that in the ED, diltiazem may be more effective than metoprolol in rapidly controlling ventricular rates.…”

Comparison of diltiazem and metoprolol for atrial fibrillation with rapid ventricular rate: Systematic review and meta-analysis

“…2 ). 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 These studies enrolled 1732 patients in emergency departments (thirteen studies) and intensive care unit settings (one study). These fourteen studies were pooled, as they each reported achievement of rate control target with diltiazem (n = 773) compared to metoprolol (n = 959) in patients with atrial fibrillation with rapid ventricular rate.…”

Oral carvedilol in escalating doses in the acute treatment of atrial fibrillation

“…In a postoperative setting including 121 patients of AF with FVR, IV diltiazem achieved stable rate control in 76% patients and IV metoprolol in 53%. [ 32 ] Though IV diltiazem and metoprolol lead to rate reduction rapidly - in 90% and 80% respectively by 20 minutes in one study[ 33 ] and IV diltiazem took a median of just 4.3 minutes in a study for rate reduction[ 34 ] - their negative inotropic effect, especially calcium channel blockers, precludes their routine use when AF is associated with significant HF or LV dysfunction. Moreover, in a recent study in 150 patients of AF with rapid ventricular rate (>120/min), the median time to achieve ventricular rate control was 3 hours with diltiazem compared to 7 hours with amiodarone and 6 hours with digoxin.…”