• J Emerg Med · Sep 2022

    Review Randomized Controlled Trial

    What is the Best Agent for Rate Control of Atrial Fibrillation With Rapid Ventricular Response?

    • Brit Long, Samuel M Keim, Michael Gottlieb, and Ian G Stiell.
    • Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas.
    • J Emerg Med. 2022 Sep 1; 63 (3): 467476467-476.

    BackgroundAtrial fibrillation (AF) is a common dysrhythmia associated with significant morbidity and mortality. Although many patients have stable AF, some patients can present with a rapid ventricular response (RVR). In these patients, it is important to lower their heart rate. However, there are several options available for rate control in the emergency department setting.Clinical QuestionWhat is the most effective agent for rate control for the patient with AF in RVR?Evidence ReviewStudies retrieved included two prospective, randomized, double-blind studies and six retrospective cohort studies. These studies provide estimates of the efficacy and safety of calcium channel blockers and β-blockers for rate control in those with AF with RVR.ConclusionBased upon the available literature, diltiazem likely achieves rate control faster than metoprolol, though both agents seem safe and effective. Clinicians must consider the individual patient, clinical situation, and comorbidities when selecting a medication for rate control.Copyright © 2022 Elsevier Inc. All rights reserved.

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