A placebo-controlled trial of continuous intravenous diltiazem infusion for 24-hour heart rate control during atrial fibrillation and atrial flutter: a multicenter study
Open accessAbstract
The safety and efficacy of a 10- to 15-mg/h continuous infusion of intravenous diltiazem were evaluated in 47 patients with atrial fibrillation or flutter who first responded to 20 mg or 20 mg followed by one or more 25-mg bolus doses of open label intravenous diltiazem. Of the 47 patients, 44 responded to the bolus injection and were randomized under double-blind conditions to receive either a continuous infusion of intravenous diltiazem (10 to 15 mg/h) (23 patients) or placebo (21 patients) for up to 24 h. Seventeen (74%) of the 23 patients receiving diltiazem infusion and none of the 21 with placebo infusion maintained a therapeutic response for 24 h (p less than 0.001). Over 24 h, patients receiving diltiazem infusion lost response significantly more slowly than did those receiving placebo infusion (p less than 0.001). Nonresponders to the double-blind infusion were given an additional bolus injection of open label intravenous diltiazem and administered an open label 24-h intravenous diltiazem infusion. The overall proportion of patients maintaining a response to a 24-h infusion of intravenous diltiazem under double-blind or open label conditions combined was 83% (34 of 41). Efficacy of the 24-h infusion of intravenous diltiazem was similar in elderly versus young patients, those who did versus those who did not receive digoxin and those weighing less than 84 versus greater than or equal to 84 kg. However, intravenous diltiazem appeared to be more effective in atrial fibrillation than in atrial flutter. No significant untoward effects were noted.(ABSTRACT TRUNCATED AT 250 WORDS)
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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 [135]
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- Authors
- Ellenbogen, K. A., Dias, V. C., Plumb, V. J., Heywood, J. T., & Mirvis, D. M.
- Affiliations
- Hunter Holmes McGuire VA Medical Center (US)
- Loma Linda University (US)
- Corresponding author
- Ellenbogen, Kenneth A.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1991-10
- Volume
- 18
- Issue
- 4
- Pages
- 891-897
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2005308598
- Cited by
- 160
- References
- 20
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 1 · 2020: 5 · 2019: 3 · 2018: 3 · 2017: 1 · 2016: 8 · 2015: 10 · 2014: 4 · 2012: 1
- FWCI
- 7.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College 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 › Heart rate and cardiovascular health
- Keywords
- diltiazem, intravenous infusion, atrial fibrillation, atrial flutter, rate control, calcium channel blockers, antiarrhythmic therapy, digoxin, cardioversion
- MeSH terms
- Aged, Atrial Fibrillation, Atrial Flutter, Diltiazem, Double-Blind Method, Female, Heart Rate, Humans, Infusions, Intravenous, Male, Time Factors
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