Highlights
- •IVP diltiazem versus metoprolol for atrial fibrillation with rapid ventricular rate.
- •Hypotension and blood pressure reduction were similar between agents.
- •Rate control was achieved more often with diltiazem.
- •Fixed diltiazem dosing was commonly used and likely impacted outcomes.
Abstract
Objective
Intravenous push (IVP) diltiazem and metoprolol are commonly used for management of
atrial fibrillation (AF) with rapid ventricular rate (RVR) in the emergency department
(ED). This study's objective was to determine if there was a significant difference
in blood pressure reduction between agents.
Methods
This was a single-center, retrospective study of adult patients initially treated
with IVP diltiazem or metoprolol in the ED from 2008 to 2018. Primary endpoint was
mean reduction in systolic blood pressure (SBP) from baseline to nadir during the
study period. Study period was defined as time from first dose of IVP intervention
to 30 min after last dose of IVP intervention or first dose of maintenance therapy,
whichever came first.
Results
A total of 63 diltiazem patients and 45 metoprolol patients met eligibility criteria.
Baseline characteristics were similar except for initial ventricular rate (VR) and
home beta-blocker use. Median dose of initial intervention was 10 [10−20] mg and 5
[5–5] mg for diltiazem and metoprolol respectively. Mean SBP reduction was 18 ± 22 mmHg
for diltiazem compared to 14 ± 15 mmHg for metoprolol (p = .33). Clinically relevant hypotension was similar between groups 14% vs. 16% (p = .86). Rate control was achieved in 35 (56%) of the diltiazem group and 16 (36%)
of the metoprolol group (p = .04).
Conclusion
IVP diltiazem and metoprolol caused similar SBP reduction and hypotension when used
for initial management of AF with RVR in the ED. However, rate control was achieved
more often with diltiazem.
Keywords
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Article Info
Publication History
Published online: June 21, 2020
Accepted:
June 6,
2020
Received in revised form:
May 4,
2020
Received:
January 14,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
