TITLE:
A Brief Review of a Common Clinical Question: Intravenous Diltiazem or Metoprolol for Atrial Fibrillation with Rapid Ventricular Response?
AUTHORS:
Zachary Visinoni, Neeladri Misra, Daniel Jurewitz
KEYWORDS:
Atrial Fibrillation, Rapid Ventricular Response, Diltiazem, Metoprolol, Heart Failure with Reduced Ejection Fraction
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.13 No.9,
September
22,
2023
ABSTRACT: Two classes of rate controlling medications—beta blockers (BBs) and non- dihydropyridine calcium channel blockers (CCBs)—are given to patients who present with atrial fibrillation (AF) with
rapid ventricular response (RVR). Both are Class I recommendations from the
American Heart Association (AHA), American College of Cardiology (ACC), and
Heart Rhythm Society (HRS) for the management of AF with RVR. Multiple studies support
the view that diltiazem is more effective than metoprolol, even though data
from the AFFIRM trial suggests BBs are more frequently used. CCBs are generally avoided in AF with RVR patients who have concomitant heart
failure with reduced ejection fraction (HFrEF) for concern of triggering decompensation.
However, some recent studies indicate this idea may be unfounded. The aim of
this article is to compare the efficacy of diltiazem and metoprolol for rate
control in AF with RVR and examine the use of diltiazem in patients with both
AF with RVR and HFrEF.