Efficacy and safety of intravenous diltiazem for treatment of atrial fibrillation and atrial flutter
Abstract
This study evaluates the effectiveness and safety of intravenous diltiazem for the treatment of atrial fibrillation and atrial flutter. A double-blind, parallel, randomized, placebo-controlled protocol was used, and 6 large, urban hospitals, both university-affiliated and private, participated. The study involved 113 patients with atrial fibrillation or flutter, a ventricular rate greater than or equal to 120 beats/min and systolic blood pressure greater than or equal to 90 mm Hg without severe heart failure. The dose of intravenous diltiazem (or identical placebo) was 0.25 mg/kg/2 minutes followed 15 minutes later by 0.35 mg/kg/2 minutes if the first dose was tolerated but ineffective. If a patient did not respond, the code was broken and the patient was allowed to receive open-label diltiazem if placebo had been given. Of 56 patients, 42 (75%) randomized to receive diltiazem responded to 0.25 mg/kg and 10 of 14 responded to 0.35 mg/kg, for a total response rate of 52 of 56 patients (93%), whereas 7 of 57 patients (12%) responded to placebo (p less than 0.001). After the double-blind protocol, 49 of the 57 patients who received placebo were then given diltiazem; 47 of 49 responded, for an overall response rate of 99 of 105 patients (94%) with diltiazem. The median time from the start of drug infusion to the maximal decrease in heart rate was 4.3 minutes. Side effects occurred in 14 patients, 7 of whom had asymptomatic hypotension not requiring intervention. Thus, intravenous diltiazem was rapidly effective for slowing the ventricular response in most patients with atrial fibrillation or atrial flutter. Blood pressure decreased slightly. Side effects were mild.
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Rate control is a particularly difficult goal in AFL, and even combination of AV node blocking drugs may fail, making cardioversion necessary.
“This is a particularly difficult goal in AFL and even the combination of AV node blocking drugs (digoxin, b blockers, calcium channel blockers) 135 -137 may fail, making cardioversion to sinus rhythm necessary.”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [137]
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- Authors
- Salerno, D. M., Dias, V. C., Kleiger, R. E., Tschida, V. H., Sung, R. J., Sami, M., & Giorgi, L. V.
- Affiliations
- San Francisco General Hospital (US)
- Corresponding author
- Salerno, David M.
- ORCID
- Salerno, David M.
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1989-05
- Volume
- 63
- Issue
- 15
- Pages
- 1046-1051
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W1998994470
- Cited by
- 152
- References
- 23
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 1 · 2021: 3 · 2020: 5 · 2019: 3 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 8 · 2014: 2 · 2013: 1 · 2012: 2
- FWCI
- 6.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, atrial flutter, ventricular rate control, calcium channel blockers, antiarrhythmic efficacy, drug safety, hypotension, placebo response
- MeSH terms
- Aged, Atrial Fibrillation, Atrial Flutter, Blood Pressure, Diltiazem, Double-Blind Method, Female, Heart Rate, Humans, Injections, Intravenous, Male, Middle Aged, Random Allocation, Multicenter Studies as Topic
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