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.

Keywords

• atrial fibrillation
• diltiazem
• ejection fraction
• emergency department
• metoprolol
• rapid ventricular response

Acil Serviste Ejeksiyon Fraksiyonu Bilinmeyen Hızlı Ventriküler Yanıtlı Atriyal Fibrilasyon Hastalarının Akut Hız Kontrolünde İntravenöz Diltiazem veya Metoprolol Uygulaması

Öz

Amaç: Atriyal fibrilasyon (AF) erişkinlerdeki en yaygın inatçı kardiyak aritmidir. Acil serviste, ejeksiyon fraksiyonu (EF) bilinmeyen hızlı ventrikül yanıtlı AF hastalarında uygulanan standart bir tedavi prosedürü yoktur. Bu çalışmanın amacı acil serviste EF'si bilinmeyen hızlı ventrikül yanıtlı AF hastalarında diltiazem ve metoprolol tedavilerinin etkinliğinin ve yan etkilerinin karşılaştırılmasıdır. Gereç ve Yöntemler: Ventriküler yanıtı ≥110/dk olan hastalar, hızlı ventrikül yanıtlı AF olarak kabul edildi. Hız kontrolünde ilk ilaç olarak 25 mg intravenöz diltiazem almış olan hastalar, ilk ilaç olarak 5 mg metoprolol almış olanlar ile karşılaştırıldı. Başvuru tarihinden önce EF değeri kaydedilmemiş olan ve acil serviste akut hız kontrolünü takiben kardiyoloji bölümüne konsülte edildikten sonra ölçülen toplam 50 hasta bu çalışmaya dahil edildi. Bulgular: İlk ilaç tedavisi olarak hastaların %56 (n=28)'sına diltiazem ve %44 (n=22)'üne metoprolol verilmişti. İkinci bir ilaç tedavisine ihtiyaç duyan hastaların oranı ise %44 (n=22) idi. EF korunmuş olanlarda diltiazem alan hastaların oranı, EF azalmış olanlara göre anlamlı derecede daha yüksek idi (p=0.032). Hastaların EF’sine göre ikinci bir uygulama ihtiyacı olma oranları arasında istatistiksel olarak anlamlı bir fark bulunmadı (p=0.157). Sonuç: Diltiazemin kalp atım hızını metoprolole göre daha erken düşürdüğü görüldü. Hızlı ventrikül yanıtlı AF’nin akut hız kontrolünde ilaç seçimi için kılavuzlar güncellenirken, EF ölçümünün elde edilemediği kırsal acil servisler de göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• atriyal fibrilasyon
• diltiazem
• ejeksiyon fraksiyonu
• acil servis
• metoprolol
• hızlı ventriküler yanıt

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