Contributor: Aaron Lessen, MD

Educational Pearls:

• Atrial fibrillation is an irregular heart rhythm that sometimes requires rate control in setting of rapid ventricular response (RVR)
• Calcium channel blocker and beta blockers are the most frequently used medications to block the AV node and slow down the heart rate in atrial fibrillation with RVR
• If a patient is on one of these agents at home, the IV form should be used first
• Recent systematic review and meta-analysis found 3 trials addressing which medication to use to control heart rate in atrial fibrillation with RVR with a total of 150 patients
• Found diltiazem, a CCB, was 4x more likely to reduce heart rate than metoprolol
• 50% of patients had a normal heart rate at 21 minutes with diltiazem versus 22% in those who received metoprolol
• Both agents had a similar decrease in blood pressure after administration

References

Jafri SH, Xu J, Warsi I, Cerecedo-Lopez CD. Diltiazem versus metoprolol for the management of atrial fibrillation: A systematic review and meta-analysis. Am J Emerg Med. 2021 Oct;48:323-327. doi: 10.1016/j.ajem.2021.06.053. Epub 2021 Jun 30. PMID: 34274577.

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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