R.E.B.E.L. EM - July 09, 2015
Article: Fromm C et al. Diltiazem vs. metoprolol in the management of atrial fibrillation or flutter with rapid ventricular rate in the emergency department. J Emerg Med 2015. PMID: 25913166
"Background: Atrial fibrillation (AF) is a commonly encountered dysrhythmia in the Emergency Department (ED). Atrial flutter is less common but its management is very similar to that of AF. In patients with chronic AF or unknown time of onset and a rapid ventricular response (RVR), rate control and consideration and initiation of anticoagulation therapy are the standard ED approach. Both beta-blockers and calcium channel blockers are commonly used for rate control in the ED but it is unclear whether one of these agents is superior to the other as there is scant high-quality data on the topic (Demircan 2005).
Clinical Question: Is diltiazem or metroprolol the more effective agent for rate control in AF with RVR in the ED?
Bottom Line: The best available evidence demonstrates that diltiazem achieves rate control faster than metoprolol in patients with AF and RVR. Diltiazem should be considered the first line agent."
http://rebelem.com/journal-update-beta-blocker-vs-calcium-channel-blocker-for-rate-control-in-atrial-fibrillation/