From the Research
The most effective treatment for atrial fibrillation with rapid ventricular rate is intravenous diltiazem, as it achieves rate control more quickly and reduces heart rate by 20% or greater more frequently than metoprolol, with no difference in safety outcomes, as shown in the study by Hirschy et al. 1.
Key Points
- Diltiazem is more effective in achieving rate control in patients with atrial fibrillation with rapid ventricular rate, with a faster time to rate control and a greater reduction in heart rate 1.
- Metoprolol is associated with a lower risk of adverse events, including hypotension and bradycardia, compared to diltiazem, as shown in the systematic review and meta-analysis by 2.
- The choice of rate control agent does not significantly influence sustained rate control success, as shown in the study by 3.
- Diltiazem and metoprolol have similar safety outcomes, including hypotension and bradycardia, as shown in the studies by 4, 1, and 3.
Treatment Recommendations
- Intravenous diltiazem is recommended as the first-line treatment for atrial fibrillation with rapid ventricular rate, due to its faster time to rate control and greater reduction in heart rate 1.
- Metoprolol may be considered as an alternative treatment option, particularly in patients with a higher risk of adverse events, such as hypotension and bradycardia 2.
- The treatment plan should be individualized based on the patient's specific needs and medical history, and should include regular monitoring of heart rate, blood pressure, and other vital signs.