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Cited by 96Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsHeart Failure Treatment and Management

Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation

Siu, Chung-Wah, Lau, Chu-Pak, Lee, Wai-Luen, Lam, Kwok-Fai, Tse, Hung-Fat·2009·Critical Care Medicine
DOI 10.1097/ccm.0b013e3181a02f56
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Abstract

OBJECTIVES: To compare the clinical efficacy of intravenous diltiazem, digoxin, and amiodarone for acute ventricular rate (VR) control in patients with acute symptomatic atrial fibrillation (AF) necessitating hospitalization. DESIGN: Randomized control trial. SETTING: Acute emergency medical admission unit in a regional teaching hospital in Hong Kong. PATIENTS: One hundred fifty adult patients with acute AF and rapid VR (>120 bpm). INTERVENTIONS: Patients were randomly assigned in 1:1:1 ratio to receive intravenous diltiazem, digoxin, or amiodarone for VR control. MEASUREMENTS AND MAIN RESULTS: The primary end point was sustained VR control (<90 bpm) within 24 hours; the secondary end points included AF symptom improvement and length of hospitalization. At 24 hours, VR control was achieved in 119 of 150 patients (79%). The time to VR control was significantly shorter among patients in the diltiazem group (log-rank test, p < 0.0001) with the percentage of patients who achieved VR control being higher in the diltiazem group (90%) than the digoxin group (74%) and the amiodarone group (74%). The median time to VR control was significantly shorter in the diltiazem group (3 hours, 1-21 hours) compared with the digoxin (6 hours, 3-15 hours, p < 0.001) and amiodarone groups (7 hours, 1-18 hours, p = 0.003). Furthermore, patients in the diltiazem group persistently had the lowest mean VR after the first hour of drug administration compared with the other two groups (p < 0.05). The diltiazem group had the largest reduction in AF symptom frequency score and severity score (p < 0.0001). In addition, length of hospital stay was significantly shorter in the diltiazem group (3.9 +/- 1.6 days) compared with digoxin (4.7 +/- 2.1 days, p = 0.023) and amiodarone groups (4.7 +/- 2.2 days, p = 0.038). CONCLUSIONS: As compared with digoxin and amiodarone, intravenous diltiazem was safe and effective in achieving VR control to improve symptoms and to reduce hospital stay in patients with acute AF.

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Crossref · 10.1097/ccm.0b013e3181a02f56

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  • For acute rate control, beta-blockers and diltiazem/verapamil are preferred over digoxin because of their rapid onset of action and effectiveness at high sympathetic tone.

    “For acute rate control, beta-blockers and diltiazem/verapamil are preferred over digoxin because of their rapid onset of action and effectiveness at high sympathetic tone.[528][529][530][531][532]”

    From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [530]

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Authors
Siu, C.-W., Lau, C.-P., Lee, W.-L., Lam, K.-F., & Tse, H.-F.
Affiliations
  • University of Hong Kong (HK)
  • Queen Mary Hospital (CN)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2009-07
Volume
37
Issue
7
Pages
2174-2179
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0b013e3181a02f56
OpenAlex
W2057342056
Cited by
96
References
37
Citations by year
2026: 1 · 2025: 8 · 2024: 5 · 2023: 6 · 2022: 2 · 2021: 5 · 2020: 8 · 2019: 5 · 2018: 6 · 2017: 5 · 2016: 10 · 2015: 5 · 2014: 8 · 2013: 6 · 2012: 4
FWCI
3.45
Type
journal article
Language
en
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
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 Failure Treatment and Management
Keywords
ventricular rate control, diltiazem, amiodarone, digoxin, intravenous antiarrhythmic drugs, acute atrial fibrillation, length of hospital stay, drug efficacy comparison, emergency department admission, symptom improvement, calcium channel blockers, beta-blockers, antiarrhythmic drugs
MeSH terms
Aged, Amiodarone, Anti-Arrhythmia Agents, Atrial Fibrillation, Digoxin, Diltiazem, Female, Humans, Infusions, Intravenous, Length of Stay, Male, Middle Aged, Cohort Studies, Treatment Outcome, Tachycardia, Ventricular

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