Intravenous Diltiazem for Controlling Ventricular Rate in Elderly Patients with Atrial Fibrillation: A Retrospective Study_West China Medical Journal

Authors：

 WANGLin ¹ , ZHOUYa-xiong ² , CHENYao ² ,  WANZhi ²

1. Department of Cardiovascular Medicine, Chengdu Shangjinnanfu Hospital, Chengdu, Sichuan 611700, P. R. China;
2. Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WANZhi, Email: 456wz@163.com

Keywords：

Atrial fibrillation; Intravenous diltiazem; Ventricular rate control

DOI：

10.7507/1002-0179.20150289

Video：

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Objective To investigate the efficacy and safety of intravenous diltiazem in controlling ventricular rate in elderly patients with atrial fibrillation. Method We retrospectively analyzed the clinical data of patients suffering from atrial fibrillation with rapid ventricular rate presented to the Emergency Department between January 2014 and January 2015, and found that 57 elderly patients aged over 70 were treated with intravenous diltiazem for ventricular rate controlling. We analyzed the general situation of this group of patients, the changes of heart rate and mean arterial pressure before and after the treatment, and the adverse reactions to the treatment. Results The total effective rate was 92.9%, and the mean onset time was (13.3±7.3) minutes. The mean arterial pressure showed no significant difference after treatment, and the heart function showed no significant deterioration. Only 4 patients (7.0%) had symptoms of transient hypotension. Conclusions For elderly patients with atrial fibrillation with rapid ventricular rate, intravenous diltiazem can control the ventricular rate rapidly, efficiently, safely, and sustainably.

Citation： WANGLin, ZHOUYa-xiong, CHENYao, WANZhi. Intravenous Diltiazem for Controlling Ventricular Rate in Elderly Patients with Atrial Fibrillation: A Retrospective Study. West China Medical Journal, 2015, 30(6): 1003-1006. doi: 10.7507/1002-0179.20150289 Copy

1.	何森, 王斯, 陈晓平. 心房颤动发病机制的研究进展[J]. 华西医学, 2012, 27(5):794-797.
2.	Aronow WS. Etiology, pathophysiology, and treatment of atrial fibrillation:part 1[J]. Cardiol Rev, 2008, 16(4):181-188.
3.	Olshansky B, Rosenfeld LE, Warner AL, et al. The atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study:approaches to control rate in atrial fibrillation[J]. J Am Coll Cardiol, 2004, 43(7):1201-1208.
4.	Berisso MZ, Fabbri G, Gonzini L, et al. Antiarrhythmic strategies in patients with atrial fibrillation managed by cardiologists and internists:Antithrombotic Agents in Atrial Fibrillation (ATA-AF) survey[J]. J Cardiovasc Med (Hagerstown), 2014, 15(8):626-635.
5.	Lip GY, Da LE. Stroke prevention in atrial fibrillation:a systematic review[J]. JAMA, 2015, 313(19):1950-1962.
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8.	汪维忠. 静注地尔硫䓬治疗肺心病快速型房颤54例疗效观察[J]. 江苏医药, 2004, 30(4):316-317.
9.	李鸣. 地尔硫卓联合地高辛治疗风湿性心脏病并快速型房颤的临床观察[J]. 河南医学研究, 2015, 24(2):124.
10.	Rogenstein C, Kelly AM, Mason S, et al. An international view of how recent-onset atrial fibrillation is treated in the emergency department[J]. Acad Emerg Med, 2012, 19(11):1255-1260.
11.	Kalus JS. Pharmacotherapeutic decision-making for patients with atrial fibrillation[J]. Am J Health Syst Pharm, 2010, 67(9 Suppl 5):S17-S25.
12.	Flaker G, Lopes RD, Hylek E, et al. Amiodarone, anticoagulation, and clinical events in patients with atrial fibrillation:insights from the Aristotle trial[J]. J Am Coll Cardiol, 2014, 64(15):1541-1550.
13.	Martindale JL, Desouza IS, Silverberg M, et al. β-Blockers versus calcium channel blockers for acute rate control of atrial fibrillation with rapid ventricular response:a systematic review[J]. Eur J Emerg Med, 2015, 22(3):150-154.
14.	Ellenbogen KA, Dias VC, Plumb VJ, et al. A placebo-controlled trial of continuous intravenous diltiazem infusion for 24-hour heart rate control during atrial fibrillation and atrial flutter:a multicenter study[J]. J Am Coll Cardiol, 1991, 18(4):891-897.
15.	Siu CW, Lau CP, Lee WL, et al. Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation[J]. Crit Care Med, 2009, 37(7):2174-2179.
16.	Personett HA, Smoot DL, Stollings JL, et al. Intravenous metoprolol versus diltiazem for rate control in noncardiac, nonthoracic postoperative atrial fibrillation[J]. Ann Pharmacother, 2014, 48(3):314-319.
17.	Demircan C, Cikriklar HI, Engindeniz Z, et al. Comparison of the effectiveness of intravenous diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation[J]. Emerg Med J, 2005, 22(6):411-414.
18.	Lee J, Kim K, Lee CC, et al. Low-dose diltiazem in atrial fibrillation with rapid ventricular response[J]. Am J Emerg Med, 2011, 29(8):849-854.

1. 何森, 王斯, 陈晓平. 心房颤动发病机制的研究进展[J]. 华西医学, 2012, 27(5):794-797.
2. Aronow WS. Etiology, pathophysiology, and treatment of atrial fibrillation:part 1[J]. Cardiol Rev, 2008, 16(4):181-188.
3. Olshansky B, Rosenfeld LE, Warner AL, et al. The atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study:approaches to control rate in atrial fibrillation[J]. J Am Coll Cardiol, 2004, 43(7):1201-1208.
4. Berisso MZ, Fabbri G, Gonzini L, et al. Antiarrhythmic strategies in patients with atrial fibrillation managed by cardiologists and internists:Antithrombotic Agents in Atrial Fibrillation (ATA-AF) survey[J]. J Cardiovasc Med (Hagerstown), 2014, 15(8):626-635.
5. Lip GY, Da LE. Stroke prevention in atrial fibrillation:a systematic review[J]. JAMA, 2015, 313(19):1950-1962.
6. January CT, Wann LS, Alpert JS, et al. College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J]. J Am Coll Cardiol, 2014, 64(21):e1-e76.
7. 李树生, 钟强, 杨光田, 等. 静脉应用地尔硫䓬治疗心效观察[J]. 中国急救医学, 1999, 19(7):18-19.
8. 汪维忠. 静注地尔硫䓬治疗肺心病快速型房颤54例疗效观察[J]. 江苏医药, 2004, 30(4):316-317.
9. 李鸣. 地尔硫卓联合地高辛治疗风湿性心脏病并快速型房颤的临床观察[J]. 河南医学研究, 2015, 24(2):124.
10. Rogenstein C, Kelly AM, Mason S, et al. An international view of how recent-onset atrial fibrillation is treated in the emergency department[J]. Acad Emerg Med, 2012, 19(11):1255-1260.
11. Kalus JS. Pharmacotherapeutic decision-making for patients with atrial fibrillation[J]. Am J Health Syst Pharm, 2010, 67(9 Suppl 5):S17-S25.
12. Flaker G, Lopes RD, Hylek E, et al. Amiodarone, anticoagulation, and clinical events in patients with atrial fibrillation:insights from the Aristotle trial[J]. J Am Coll Cardiol, 2014, 64(15):1541-1550.
13. Martindale JL, Desouza IS, Silverberg M, et al. β-Blockers versus calcium channel blockers for acute rate control of atrial fibrillation with rapid ventricular response:a systematic review[J]. Eur J Emerg Med, 2015, 22(3):150-154.
14. Ellenbogen KA, Dias VC, Plumb VJ, et al. A placebo-controlled trial of continuous intravenous diltiazem infusion for 24-hour heart rate control during atrial fibrillation and atrial flutter:a multicenter study[J]. J Am Coll Cardiol, 1991, 18(4):891-897.
15. Siu CW, Lau CP, Lee WL, et al. Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation[J]. Crit Care Med, 2009, 37(7):2174-2179.
16. Personett HA, Smoot DL, Stollings JL, et al. Intravenous metoprolol versus diltiazem for rate control in noncardiac, nonthoracic postoperative atrial fibrillation[J]. Ann Pharmacother, 2014, 48(3):314-319.
17. Demircan C, Cikriklar HI, Engindeniz Z, et al. Comparison of the effectiveness of intravenous diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation[J]. Emerg Med J, 2005, 22(6):411-414.
18. Lee J, Kim K, Lee CC, et al. Low-dose diltiazem in atrial fibrillation with rapid ventricular response[J]. Am J Emerg Med, 2011, 29(8):849-854.

West China Medical Journal

Intravenous Diltiazem for Controlling Ventricular Rate in Elderly Patients with Atrial Fibrillation: A Retrospective Study

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