By Najm Haque, PGY2 Atrial fibrillation with rapid ventricular response is a common emergency room problem. Patient with stable blood pressure who present in Afib with RVR need medications to control their heart rate (unstable patients require more cardioversion). Traditionally, these patients receive beta blockers or calcium channel blockers in IV form for rate control. The most common medications used in the US are metoprolol and diltiazem, but it is unclear which is superior. Fromm et al This study was published in the Journal of Emergency Medicine in April 2015 and compared how fast rate control was achieved in diltiazem vs metoprolol. This was a prospective, double-blind study which compared the effects of both medications at 30 minutes, as well as looking at mean decrease in heart rate, and adverse effects. Patients were randomized and either received Diltiazem 0.25 mg/kg IVP (maximum dose of 30mg) or Metoprolol 0.15mg/kg IVP (maximum dose of 10mg). where can you buy nolvadex online BACKGROUND Diltiazem (calcium channel blocker) and metoprolol (beta-blocker) are both commonly used to treat atrial fibrillation/flutter (AFF) in the emergency department (ED). However, there is considerable regional variability in emergency physician practice patterns and debate among physicians as to which agent is more effective. To date, only one small prospective, randomized trial has compared the effectiveness of diltiazem and metoprolol for rate control of AFF in the ED and concluded no… Safest way to order viagra online Duloxetine hcl 30mg Buy cialis professional 20 mg Compare Diltiazem vs Lopressor - Diltiazem works well to lower blood pressure and prevent chest pain, but you have Lopressor metoprolol tartrate lowers high blood pressure, controls chest Cardizem diltiazem Alternatives & Similar Drugs - Substitutes and alternatives to Cardizem diltiazem for uses like High blood. best way to order viagra online The results of the study showed that diltiazem reached the target HR of 100 much more frequently at 5 minutes 50% vs 10.7% and at 30 minutes 95.8% vs 46.4% when compared to metoprolol. There was no difference in adverse effects. Significant predictors of the selection of metoprolol versus diltiazem included a past history of AF odds ratio OR, 8.3; 95% confidence interval. Objective: To compare the effectiveness of intravenous (IV) diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation (AF). Methods: This prospective, randomised study was conducted in the Emergency Department of the Uludag University Medical Faculty Hospital, Bursa, Turkey. Forty AF patients with a ventricular rate ⩾120/minute and systolic blood pressure ⩾95 mm Hg were included and randomised to receive IV diltiazem 0.25 mg/kg (maximum 25 mg) or metoprolol 0.15 mg/kg (maximum 10 mg) over 2 minutes. Blood pressures and heart rate were measured at 2, 5, 10, 15, and 20 minutes. Successful treatment was defined as fall in ventricular rate to below 100/minute or decrease in ventricular rate by 20% or return to sinus rhythm. Results: Between January 2000 and July 2002, 40 patients (18 men, 22 women) met the inclusion criteria. Of these 20 (8 men, 12 women; mean age 60.2 years, range 31–82) received diltiazem and 20 (10 men, 10 women; mean age 64.0 years, range 31–82) received metoprolol. Authors’ Conclusions: “Diltiazem was more effective in achieving rate control in ED patients with AFF and did so with no increased incidence of adverse effects.” Key Results: There were 28 patients randomized to the metoprolol group and 24 in the diltiazem group. About two-thirds of the patients were new-onset atrial fibrillation. The mean age was 66 years, and 47 percent were men. No difference was noted between the groups in terms of bradycardia or hypotension. Ken Milne, MD, is chief of emergency medicine and chief of staff at South Huron Hospital, Ontario, Canada. He is on the Best Evidence in Emergency Medicine faculty and is creator of the knowledge translation project the Skeptics Guide to Emergency Medicine. Metoprolol vs diltiazem A comparison of diltiazem and metoprolol in hypertension., Dilt v. Metoprolol in Afib/RVR - Jacobi Emergency Medicine Canadianpharmacy Metoprolol kidney function The success rate at 20 minutes for diltiazem and metoprolol was 90% n = 18. Recent trials the rate control versus electrical cardioversion for persistent atrial. Comparison of the effectiveness of intravenous diltiazem and. Diltiazem versus metoprolol for rate control in atrial fibrillation with. Compare Diltiazem vs Lopressor - Compared with baseline, diltiazem treatment significantly reduced both. metoprolol and carvedilol improved neither frequency nor severity. purchase cialis in usa Diltiazem vs. Metoprolol in the Acute Management of AF in Patients With HFrEF The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U. S. Federal Government. To date, only one small prospective, randomized trial has compared the effectiveness of diltiazem and metoprolol for rate control of AFF in the ED and concluded.