Low-dose diltiazem in atrial fibrillation with rapid ventricular response

Lee, Jungyoup; Kim, Kyuseok; Lee, Christopher C.; Nam, Yeoun Woo; Lee, Jin Hee; Rhee, Joong Eui; Singer, Adam J.; Kim, Kyung Soo; Ro, Youngsun

doi:10.1016/j.ajem.2010.03.021

Cited by 19 publications

(24 citation statements)

References 7 publications

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“…In clinical practice, the dose of diltiazem administered to patients with AF and rapid ventricular response is variable. In one retrospective observational study, doses of 0.2 mg/kg or less of diltiazem were administered to one- third of patients presenting to the ED with AF and rapid ventricular response [15]. Hypotension, defined as systolic blood pressure less than 90, was observed in 1/61 patients who received 0.2 mg/kg or less, 6/83 patients who received more than 0.2 mg/kg, and 0.3 mg/kg or less, and 1/36 patients who received more than 0.3 mg/kg.…”

Section: Discussionmentioning

confidence: 99%

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

Martindale

deSouza

Silverberg

et al. 2015

European Journal of Emergency Medicine

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This is a systematic review of the literature to compare the efficacy of calcium channel blockers to β-blockers for acute rate control of atrial fibrillation with rapid ventricular response in the emergency department setting. PubMed, EMBASE, and the Cochrane Registry were searched. Relative risk (95% confidence interval) was calculated between drugs and methodological quality of included studies was evaluated. Of the 1003 studies yielded by our initial search, two met inclusion criteria and provided sufficient data. These were randomized double-blinded studies (n=92) comparing intravenous diltiazem with intravenous metoprolol. The combined relative risk of acute rate control by diltiazem versus metoprolol was 1.8 (95% confidence interval 1.2-2.6). On the basis of the paucity of available evidence, diltiazem may be more effective than metoprolol in achieving rapid rate control, but high-quality randomized studies are needed.

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Section: Discussionmentioning

confidence: 99%

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

Martindale

deSouza

Silverberg

et al. 2015

European Journal of Emergency Medicine

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“…However, neither study reported important outcomes including consultations, admission rate, LOS, and out‐of‐hospital outcomes such as stroke or death. In a description of low‐dose diltiazem for ventricular rate control, Lee and coworkers documented that approximately one‐third of patients had a 20% reduction in systolic blood pressure, but did not elaborate on subsequent ED treatments or other management decisions or patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficiency of Calcium Channel Blockers Versus Beta‐blockers for Rate Control in Patients With Atrial Fibrillation and No Acute Underlying Medical Illness

Scheuermeyer

Grafstein

Stenstrom

et al. 2013

Academic Emergency Medicine

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Objectives Many patients with atrial fibrillation (AF) are not candidates for rhythm control and may require rate control, typically with beta‐blocking (BB) or calcium channel blocking (CCB) agents. Although these patients appear to have a low 30‐day rate of stroke or death, it is unclear if one class of agent is safer or more effective. The objective was to determine whether BBs or CCBs would have a lower hospital admission rate and to measure 30‐day safety outcomes including stroke, death, and emergency department (ED) revisits. Methods This retrospective cohort study used a database from two urban EDs to identify consecutive patients with ED discharge diagnoses of AF from April 1, 2006, to March 31, 2010. Comorbidities, rhythms, management, and immediate outcomes were obtained by manual chart review, and patients with acute underlying medical conditions were excluded by predefined criteria. Patients managed only with rate control agents were eligible for review, and patients receiving BB agents were compared to those receiving CCB agents. The primary outcome was the proportion of patients requiring hospital admission; secondary outcomes included the ED length of stay (LOS), the proportion of patients having adverse events, the proportion of patients returning within 7 or 30 days, and the number of patients having a stroke or dying within 30 days. Results A total of 259 consecutive patients were enrolled, with 100 receiving CCBs and 159 receiving BBs. Baseline demographics and comorbidities were similar. Twenty‐seven percent of BB patients were admitted, and 31.0% of CCB patients were admitted (difference = 4.0%, 95% confidence interval [CI] = −7.7% to 16.1%), and there were no significant differences in ED LOS, adverse events, or 7‐ or 30‐day ED revisits. One patient who received metoprolol had a stroke, and one patient who received diltiazem died within 30 days. Conclusions In this cohort of ED patients with AF and no acute underlying medical illness who underwent rate control only, patients receiving CCBs had similar hospital admission rates to those receiving BBs, while both classes of medications appeared equally safe at 30 days. Both CCBs and BBs are acceptable options for rate control.

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“…22 Diltiazem is classically dosed at 0.25 mg/kg intravenously (IV) over 2 minutes, although doses less than 0.2 mg/kg have been shown to be effective with a decreased risk of hypotension. 23 In addition to hypotension, the possible Goralnick & Bontempo side effects of calcium channel antagonists are heart block and HF because of their negative ionotropic effects. These antagonists, therefore, should not be used in the treatment of patients with decompensated HF.…”

Section: Rate Controlmentioning

confidence: 99%

Atrial Fibrillation

Goralnick

Bontempo

2015

Emergency Medicine Clinics of North America

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Atrial fibrillation (AF) is a supraventricular tachyarrhythmia that results from the chaotic depolarization of atrial tissue. AF is the most common sustained cardiac dysrhythmia and the most common dysrhythmia diagnosed in US emergency departments. All patients with AF must have their cardioembolic risk assessed, even if sinus rhythm is restored. Novel oral anticoagulants may be considered instead of vitamin K antagonists for anticoagulation in patients with nonvalvular AF.

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Low-dose diltiazem in atrial fibrillation with rapid ventricular response

Cited by 19 publications

References 7 publications

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

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

Safety and Efficiency of Calcium Channel Blockers Versus Beta‐blockers for Rate Control in Patients With Atrial Fibrillation and No Acute Underlying Medical Illness

Atrial Fibrillation

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