Düzce Tıp Fakültesi Dergisi (Apr 2021)
Intravenous Diltiazem or Metoprolol Administration in the Emergency Department for Acute Rate Control of Atrial Fibrillation Patients with Rapid Ventricular Response with Unknown Ejection Fraction
Abstract
Aim: Atrial fibrillation (AF) is the most widespread persistent cardiac arrhythmia in adults. There is no standard procedure applied in AF patients with rapid ventricular response with unknown ejection fraction (EF) in the emergency department. This study aimed to compare the effectiveness and side effects of diltiazem and metoprolol treatments without knowing the EF in AF patients with rapid ventricular response in the emergency department. Material and Methods: Patients with a ventricular response ≥110/min were selected as having AF with rapid ventricular response. The patients first received 25 mg intravenous diltiazem as a rate control drug were compared with those first received 5 mg metoprolol. A total of 50 patients whose EF were not registered before the admission date and was measured after being consulted for cardiology following acute rate control in emergency department were included in this study. Results: For the first drug treatment, diltiazem was given to 56% (n=28) of the patients and metoprolol to 44% (n=22). Moreover, 44% (n=22) of the patients needed a second drug infusion. The proportion of patients received diltiazem in those with preserved EF was significantly higher than those with reduced EF (p=0.032). No statistically significant difference was found between the rates of needing a second administration based on the EF (p=0.157). Conclusion: Diltiazem was found to reduce heart rate earlier than metoprolol. While updating the guidelines for drug selection in acute rate control of AF with rapid ventricular response, rural emergency departments, where EF measurement cannot be achieved, should also be considered.
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