比较美托洛尔与地尔硫卓对快速心室率心房颤动的持续率控制。
Comparison of sustained rate control in atrial fibrillation with rapid ventricular rate: Metoprolol vs. Diltiazem.
机构信息
University Health, San Antonio, TX 78229, United States; University of Texas Health San Antonio, Pharmacotherapy Education & Research Center, San Antonio, TX 78229, United States; The University of Texas at Austin, College of Pharmacy, Austin, TX 78712, United States; University of the Incarnate Word, Feik School of Pharmacy, San Antonio, TX 78209, United States.
University Health, San Antonio, TX 78229, United States; University of Texas Health San Antonio, Pharmacotherapy Education & Research Center, San Antonio, TX 78229, United States; The University of Texas at Austin, College of Pharmacy, Austin, TX 78712, United States; University of the Incarnate Word, Feik School of Pharmacy, San Antonio, TX 78209, United States.
出版信息
Am J Emerg Med. 2021 Feb;40:15-19. doi: 10.1016/j.ajem.2020.11.073. Epub 2020 Dec 3.
OBJECTIVE
The objective of this study was to compare sustained rate control with intravenous (IV) diltiazem vs. IV metoprolol in acute treatment of atrial fibrillation (AF) with rapid ventricular rate (RVR) in the emergency department (ED).
METHODS
This retrospective chart review at a large, academic medical center identified patients with AF with RVR diagnosis who received IV diltiazem or IV metoprolol in the ED. The primary outcome was sustained rate control defined as heart rate (HR) < 100 beats per minute without need for rescue IV medication for 3 h following initial rate control attainment. Secondary outcomes included time to initial rate control, HR at initial control and 3 h, time to oral dose, admission rates, and safety outcomes.
RESULTS
Between January 1, 2016 and November 1, 2018, 51 patients met inclusion criteria (diltiazem n = 32, metoprolol n = 19). No difference in sustained rate control was found (diltiazem 87.5% vs. metoprolol 78.9%, p = 0.45). Time to rate control was significantly shorter with diltiazem compared to metoprolol (15 min vs. 30 min, respectively, p = 0.04). Neither hypotension nor bradycardia were significantly different between groups.
CONCLUSIONS
Choice of rate control agent for acute management of AF with RVR did not significantly influence sustained rate control success. Safety outcomes did not differ between treatment groups.
目的
本研究旨在比较静脉注射（IV）地尔硫卓与 IV 美托洛尔在急诊科（ED）急性治疗快速心室率（RVR）的心房颤动（AF）中的持续心率控制效果。
方法
这项在一家大型学术医疗中心进行的回顾性图表研究，确定了在 ED 接受 IV 地尔硫卓或 IV 美托洛尔治疗的 RVR 诊断为 AF 的患者。主要结局是持续心率控制，定义为初始心率控制后 3 小时内无需再次使用 IV 药物来维持心率<100 次/分钟。次要结局包括初始心率控制时间、初始控制和 3 小时时的心率、口服药物时间、入院率和安全性结局。
结果
在 2016 年 1 月 1 日至 2018 年 11 月 1 日期间，有 51 名患者符合纳入标准（地尔硫卓组 n=32，美托洛尔组 n=19）。两组在持续心率控制方面无显著差异（地尔硫卓组 87.5%，美托洛尔组 78.9%，p=0.45）。地尔硫卓组的心率控制时间明显短于美托洛尔组（分别为 15 分钟和 30 分钟，p=0.04）。两组的低血压和心动过缓发生率均无显著差异。
结论
在急诊科急性治疗 RVR 的 AF 时，选择心率控制药物对持续心率控制成功率没有显著影响。两组的安全性结局没有差异。
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