Rate control with intravenous diltiazem, verapamil, and metoprolol in acute atrial fibrillation with rapid ventricular rate

INTRODUCTION: Diltiazem is a preferred agent for rate control in atrial fibrillation due to its quick onset, minimal side effects, and low cost. Due to its intermittent national shortage since February 2018, the utilization of intravenous metoprolol and verapamil has increased. This study investigated the effect of intravenous diltiazem, metoprolol, and verapamil on rate control in patients with atrial fibrillation with rapid ventricular rate. METHODS: This study was a retrospective, single-center, cohort study conducted in patients with acute atrial fibrillation receiving intravenous diltiazem, metoprolol, or verapamil for rapid ventricular rate between 1 January 2012 and 31 August 2018. The primary outcome was the incidence of patients who achieved a rate less than 100 bpm within 1 h of treatment. Secondary outcomes included time to achieve rate control, heart rate at 30 min and 1 h after administration, bradycardia and hypotension incidence, the requirement of other rate control agent(s), inpatient admission, length of stay, and mortality. RESULTS: A total of 73 patients were included in the study. At 1 h after receiving the initial rate control drug, there was no statistically significant difference between diltiazem, metoprolol, and verapamil in achieving rate control. Median time to ventricular rate control was 166 min in the diltiazem group, 297 min in the metoprolol group, and 100.5 min in the verapamil group. CONCLUSION: There was no difference in achieving rate control when using intravenous diltiazem, metoprolol, or verapamil. Any of the three rate control agents may be used for rate control. However, further studies are needed to determine which agent is superior for rate control.