What's the best for AF rate control?

How are you rate-controlling your a-fibers these days? Everyone has their own concoction, but since we now stock IV diltiazem (which is a first line treatment that most of us Yanks learned), we thought we might share a recent publication in Critical Care Medicine with you.

Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation.

This RCT was conducted in a teaching hospital in Hong Kong where they enrolled 150 adult patients with acute AF and rapid VR (>120 bpm) who were then randomized to receive IV diltiazem, amiodarone or digoxin for rate control. The primary end point was sustained VR control (<90 bpm) within 24 hours; the secondary end points included AF symptom improvement and length of hospitalization. At 24 hours, VR control was achieved in 119 of 150 patients. The Diltizem had a significantly shorter time to rate control. It also took top honors in the “percentage of patients who achieved VR control” as well as “shortest median time to VR rate control” and the “lowest mean VR after the first hour of drug administration “ and the “shortest length of hospital stay” catagories.

The conclusions that the authors draw: As compared with digoxin and amiodarone, intravenous diltiazem was safe and effective in achieving VR control to improve symptoms and to reduce hospital stay in patients with acute AF. What do ya‟ll think? Chip

Crit Care Med. 2009 Jul;37(7):2174-9