To compare the clinical efficacy of intravenous diltiazem
, and amiodarone
for acute ventricular rate (VR) control in patients with acute symptomatic atrial fibrillation
(AF) necessitating hospitalization.
Randomized control trial.
Acute emergency medical admission unit in a regional teaching hospital in Hong Kong.
One hundred fifty adult patients with acute AF and rapid VR (>120 bpm).
Patients were randomly assigned in 1:1:1 ratio to receive intravenous diltiazem
, 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
As compared with digoxin
, intravenous diltiazem
was safe and effective in achieving VR control to improve symptoms and to reduce hospital stay in patients with acute AF.