Safety of Intravenous Diltiazem in Reduced Ejection Fraction Heart Failure with Rapid Atrial Fibrillation

Jandali, Mohamad Badr

doi:10.1007/s40261-018-0631-7

Cited by 15 publications

(5 citation statements)

References 22 publications

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“…50%). 526 There was no difference in the rates of hypotension, intensive care unit (ICU) transfer, or mortality between the patients with LVEF ! 50% vs those with LVEF < 50%, or those with LVEF !…”

Section: Acute Rate Controlmentioning

confidence: 99%

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

Andrade

Aguilar

Atzema

et al. 2020

Canadian Journal of Cardiology

426

496

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The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published R ESUM ELe programme de lignes directrices de la Soci et e canadienne de cardiologie (SCC) en matière de fibrillation auriculaire (FA) a et e elabor e pour aider les cliniciens à prendre en charge ces patients complexes, ainsi que pour orienter les d ecideurs politiques et les systèmes de soins de sant e sur des questions connexes. La dernière edition

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Section: Acute Rate Controlmentioning

confidence: 99%

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

Andrade

Aguilar

Atzema

et al. 2020

Canadian Journal of Cardiology

426

496

View full text Add to dashboard Cite

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“…In a retrospective analysis of patients hospitalized with AF with rapid ventricular rate (RVR), diltiazem was associated with an increased risk of acute kidney injury within 48 hours of initiation of diltiazem in those patients with LVEF ≤50%, compared with those with normal EF (10% versus 3.6%; P =0.002). 14 An additional retrospective analysis compared patients with HFrEF receiving either intravenous metoprolol or diltiazem. There was a higher incidence of worsening HF symptoms (increased oxygen requirement within 4 hours or initiation of inotropic support with 48 hours) in those patients receiving diltiazem (33% versus 15%; P =0.019).…”

Section: Rate Controlmentioning

confidence: 99%

“…In the acute setting, limited data from 2 retrospective analyses suggest the potential for increased morbidity with the use of diltiazem in patients with HFrEF, including worsening HF, need for inotropic support, or acute kidney injury. 57,58 In the chronic setting, diltiazem had no impact on mortality in a trial of patients with nonischemic cardiomyopathy. 59 However, in the multicenter randomized MDPIT of patients postacute MI, HF and cardiac events (cardiac death or nonfatal reinfarction) were more frequent in the patients with LVEF <40% or pulmonary congestion who were randomized to diltiazem.…”

Section: Management Of Patients With Hfmentioning

confidence: 99%

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Joglar,

Chung,

Armbruster

et al. 2024

Circulation

566

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AIM The “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation” provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the “2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” and the “2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

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“…Indeed, the 2014 ACC/AHA/HRS guideline explicitly states that, “In the setting of acute AF…non‐dihydropyridine CCBs should not be used in patients with [left ventricular] systolic dysfunction and decompensated [heart failure] because of their negative inotropic effects.” 4 However, no references for this statement are given and, of the seven studies referenced elsewhere in the nondihydropyridine CCBs section and online data supplement of the 2014 statement, none include patients with AFRVR and ADHF managed in the acute setting. The Canadian guidelines do not comment on the specific use of nondihydropyridine CCBs for patients with concurrent AFRVR and decompensated heart failure; however, they note that the selective use of IV CCBs and BBs have been “safely and successfully used in several randomized and non‐randomized studies.” 23 The two nonrandomized studies cited analyzed use of BB and BB versus CCB, respectively, 26,27 but excluded patients with decompensated heart failure. The single randomized study is the study by Goldenberg et al 16 study included in this systematic review in which patients received diltiazem or placebo.…”

Section: Discussionmentioning

confidence: 99%

Management of atrial flutter and atrial fibrillation with rapid ventricular response in patients with acute decompensated heart failure: A systematic review

Niforatos¹,

Ehmann²,

Balhara³

et al. 2022

Academic Emergency Medicine

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Objective The objective was to evaluate the comparative effectiveness and safety of pharmacological and nonpharmacological management options for atrial fibrillation/atrial flutter with rapid ventricular response (AFRVR) in patients with acute decompensated heart failure (ADHF) in the acute care setting. Methods This study was a systematic review of observational studies or randomized clinical trials (RCT) of adult patients with AFRVR and concomitant ADHF in the emergency department (ED), intensive care unit, or step‐down unit. The primary effectiveness outcome was successful rate or rhythm control. Safety outcomes were adverse events, such as symptomatic hypotension and venous thromboembolism. Results A total of 6577 unique articles were identified. Five studies met inclusion criteria: one RCT in the inpatient setting and four retrospective studies, two in the ED and the other three in the inpatient setting. In the RCT of diltiazem versus placebo, 22 patients (100%) in the treatment group had a therapeutic response compared to 0/15 (0%) in the placebo group, with no significant safety differences between the two groups. For three of the observational studies, data were limited. One observation study showed no difference between metoprolol and diltiazem for successful rate control, but worsening heart failure symptoms occurred more frequently in those receiving diltiazem compared to metoprolol (19 patients [33%] vs. 10 patients [15%], p = 0.019). A single study included electrical cardioversion (one patient exposed with failure to convert to sinus rhythm) as nonpharmacological management. The overall risk of bias for included studies ranged from serious to critical. Missing data and heterogeneity of definitions for effectiveness and safety outcomes precluded the combination of results for quantitative meta‐analysis. Conclusions High‐level evidence to inform clinical decision making regarding effective and safe management of AFRVR in patients with ADHF in the acute care setting is lacking.

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Safety of Intravenous Diltiazem in Reduced Ejection Fraction Heart Failure with Rapid Atrial Fibrillation

Abstract: Intravenous diltiazem in patients who have decreased EF may be associated with increased risk of acute kidney injury, but not increased risk of hypotension, intensive care unit transfer, or in-hospital mortality.

Cited by 15 publications

References 22 publications

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Management of atrial flutter and atrial fibrillation with rapid ventricular response in patients with acute decompensated heart failure: A systematic review

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