Zitek Tony, Pagano Kristina, Fernandez Carolina, Zajd Sarah, Akhter Murtaza, Kheradia Tarang, Vaidean Georgeta, Farcy David A
Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA.
Herbert Wertheim College of Medicine at Florida International University, Miami, Florida, USA.
Acad Emerg Med. 2024 Dec;31(12):1264-1272. doi: 10.1111/acem.14989. Epub 2024 Jul 27.
Emergency physicians commonly treat patients with atrial fibrillation (AF) or atrial flutter (AFL) with rapid ventricular response, and intravenous (IV) diltiazem is the most commonly used medication for rate control of such patients. We sought to compare rate control success and safety outcomes for emergency department (ED) patients with AF or AFL who, after a diltiazem bolus, received a diltiazem drip compared to those who did not receive a drip.
We performed a retrospective cohort study comparing outcomes of ED patients from a single hospital system with AF and AFL and a heart rate (HR) > 100 beats/min who received a diltiazem drip after an IV diltiazem bolus to those who received no drip. The primary outcome was a HR < 100 beats/min at the time of ED disposition. Secondary outcomes were hospital length of stay and safety (hypotension, electrical cardioversion, vasopressor use, and death). We compared groups using propensity score matching.
Between January 1, 2020, and November 8, 2022, there were 746 AF or AFL patients eligible for analysis. Of those, 382 (51.2%) received a diltiazem drip and 364 (48.8%) did not. In the unadjusted analysis, the last recorded ED HR was <100 beats/min in 55.2% of patients in the drip group compared to 65.9% in the no-drip group (difference 10.7%, 95% confidence interval [CI] 3.7 to 17.7). After propensity matching, diltiazem drip use was associated with lower likelihood of rate control in the ED (OR 0.69, 95% CI 0.48-0.99) and 22.5 h (95% CI 12.2-36.8) longer hospital stay.
For patients with AF or AFL, the use of a diltiazem drip after an IV diltiazem bolus was associated with less rate control in the ED.
急诊科医生经常治疗伴有快速心室率的心房颤动（AF）或心房扑动（AFL）患者，静脉注射地尔硫䓬是这类患者心率控制最常用的药物。我们试图比较急诊科（ED）中，接受地尔硫䓬推注后再接受地尔硫䓬滴注的AF或AFL患者与未接受滴注的患者在心率控制成功率和安全性方面的结果。
我们进行了一项回顾性队列研究，比较了来自单一医院系统的伴有AF和AFL且心率（HR）>100次/分钟的ED患者，在静脉注射地尔硫䓬推注后接受地尔硫䓬滴注与未接受滴注的患者的结局。主要结局是ED处置时HR<100次/分钟。次要结局是住院时间和安全性（低血压、电复律、血管升压药使用和死亡）。我们使用倾向评分匹配比较组间情况。
在2020年1月1日至2022年11月8日期间，有746例AF或AFL患者符合分析条件。其中，382例（51.2%）接受了地尔硫䓬滴注，364例（48.8%）未接受。在未调整分析中，滴注组55.2%的患者最后记录的ED心率<100次/分钟，而未滴注组为65.9%（差异10.7%，95%置信区间[CI]3.7至17.7）。倾向匹配后，使用地尔硫䓬滴注与ED中较低的心率控制可能性（OR 0.69，95%CI 0.48 - 0.99）以及延长22.5小时（95%CI 12.2 - 36.8）的住院时间相关。
对于AF或AFL患者，静脉注射地尔硫䓬推注后使用地尔硫䓬滴注与ED中较低的心率控制相关。
