Loyola University Medical Center, Maywood, IL 60153, United States.
Boston Medical Center, Boston, MA 02118, United States.
Am J Emerg Med. 2019 Jan;37(1):80-84. doi: 10.1016/j.ajem.2018.04.062. Epub 2018 Apr 27.
The objective of this study was to examine the effects of metoprolol versus diltiazem in the acute management of atrial fibrillation (AF) with rapid ventricular response (RVR) in patients with heart failure with reduced ejection fraction (HFrEF).
This retrospective cohort study of patients with HFrEF in AF with RVR receiving either intravenous push (IVP) doses of metoprolol or diltiazem was conducted between January 2012 and September 2016. The primary outcome was successful rate control within 30 min of medication administration, defined as a heart rate (HR) < 100 beats per minute or a HR reduction ≥ 20%. Secondary outcomes included rate control at 60 min, maximum median change in HR, and incidence of hypotension, bradycardia, or conversion to normal sinus rhythm within 30 min. Signs of worsening heart failure were also evaluated.
Of the 48 patients included, 14 received metoprolol and 34 received diltiazem. The primary outcome, successful rate control within 30 min, occurred in 62% of the metoprolol group and 50% of the diltiazem group (p = 0.49). There was no difference in HR control at predefined time points or incidence of hypotension, bradycardia, or conversion. Although baseline HR varied between groups, maximum median change in HR did not differ. Signs of worsening heart failure were similar between groups.
For the acute management of AF with RVR in patients with HFrEF, IVP diltiazem achieved similar rate control with no increase in adverse events when compared to IVP metoprolol.
本研究旨在观察美托洛尔与地尔硫卓在射血分数降低的心力衰竭（HFrEF）合并快速心室率（RVR）的心房颤动（AF）患者急性治疗中的效果。
本回顾性队列研究纳入了 2012 年 1 月至 2016 年 9 月期间接受静脉推注（IVP）美托洛尔或地尔硫卓的 HFrEF 合并 RVR 的 AF 患者。主要结局为药物治疗后 30 分钟内心率控制成功率，定义为心率（HR）<100 次/分钟或 HR 降低≥20%。次要结局包括 60 分钟时的心率控制、最大 HR 中位数变化以及 30 分钟内低血压、心动过缓或恢复窦性心律的发生率。还评估了心力衰竭恶化的迹象。
在纳入的 48 例患者中，14 例接受美托洛尔，34 例接受地尔硫卓。主要结局为 30 分钟内心率控制成功率，美托洛尔组为 62%，地尔硫卓组为 50%（p=0.49）。两组在预定时间点的 HR 控制或低血压、心动过缓或恢复窦性心律的发生率均无差异。尽管两组的基础 HR 不同，但最大 HR 中位数变化无差异。心力衰竭恶化的迹象在两组之间相似。
对于 HFrEF 合并 RVR 的 AF 患者的急性治疗，与 IVP 美托洛尔相比，IVP 地尔硫卓可实现相似的心率控制，且不良反应发生率无增加。
