Medeiros Tia, Bui Vi, Almekdash Mhd Hasan, Keesari Rohali, Lee Young R
Hendrick Medical Center, Abilene, TX, USA.
Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, TX, USA.
SAGE Open Med. 2021 May 25;9:20503121211017756. doi: 10.1177/20503121211017756. eCollection 2021.
Diltiazem is a preferred agent for rate control in atrial fibrillation due to its quick onset, minimal side effects, and low cost. Due to its intermittent national shortage since February 2018, the utilization of intravenous metoprolol and verapamil has increased. This study investigated the effect of intravenous diltiazem, metoprolol, and verapamil on rate control in patients with atrial fibrillation with rapid ventricular rate.
This study was a retrospective, single-center, cohort study conducted in patients with acute atrial fibrillation receiving intravenous diltiazem, metoprolol, or verapamil for rapid ventricular rate between 1 January 2012 and 31 August 2018. The primary outcome was the incidence of patients who achieved a rate less than 100 bpm within 1 h of treatment. Secondary outcomes included time to achieve rate control, heart rate at 30 min and 1 h after administration, bradycardia and hypotension incidence, the requirement of other rate control agent(s), inpatient admission, length of stay, and mortality.
A total of 73 patients were included in the study. At 1 h after receiving the initial rate control drug, there was no statistically significant difference between diltiazem, metoprolol, and verapamil in achieving rate control. Median time to ventricular rate control was 166 min in the diltiazem group, 297 min in the metoprolol group, and 100.5 min in the verapamil group.
There was no difference in achieving rate control when using intravenous diltiazem, metoprolol, or verapamil. Any of the three rate control agents may be used for rate control. However, further studies are needed to determine which agent is superior for rate control.
地尔硫䓬因其起效迅速、副作用极小且成本低廉，是心房颤动心率控制的首选药物。自2018年2月以来，由于其在全国范围内间歇性短缺，静脉注射美托洛尔和维拉帕米的使用有所增加。本研究调查了静脉注射地尔硫䓬、美托洛尔和维拉帕米对快速心室率心房颤动患者心率控制的影响。
本研究是一项回顾性、单中心队列研究，研究对象为2012年1月1日至2018年8月31日期间因快速心室率接受静脉注射地尔硫䓬、美托洛尔或维拉帕米治疗的急性心房颤动患者。主要结局是治疗1小时内心率降至100次/分钟以下的患者发生率。次要结局包括达到心率控制的时间、给药后30分钟和1小时的心率、心动过缓和低血压发生率、其他心率控制药物的需求、住院情况、住院时间和死亡率。
共有73例患者纳入本研究。在接受初始心率控制药物1小时后，地尔硫䓬、美托洛尔和维拉帕米在实现心率控制方面无统计学显著差异。地尔硫䓬组心室率控制的中位时间为166分钟，美托洛尔组为297分钟，维拉帕米组为100.5分钟。
使用静脉注射地尔硫䓬、美托洛尔或维拉帕米在实现心率控制方面没有差异。这三种心率控制药物中的任何一种都可用于心率控制。然而，需要进一步研究以确定哪种药物在心率控制方面更具优势。
