• Kristi L Hargrove, Ellen E Robinson, Kathleen A Lusk, Darrel W Hughes, Luke A Neff, and Amanda L Fowler.
• 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. Electronic address: kristi.hargrove@uhs-sa.com.
• Am J Emerg Med. 2021 Feb 1; 40: 15-19.

ObjectiveThe 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).MethodsThis 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.ResultsBetween 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.ConclusionsChoice 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.Copyright © 2020 Elsevier Inc. All rights reserved.

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