Key result
Review supports beta blockers as first-line for acute AF RVR in HFrEF with diltiazem second.
Why the study?
Recommendations against nondihydropyridine calcium channel blockers for acute rate control in patients with AF RVR and comorbid HFrEF are extrapolated from chronic studies that did not analyze comorbid AF.
Are nondihydropyridine calcium channel blockers safe and effective for acute rate control in patients with atrial fibrillation with rapid ventricular response and comorbid HFrEF?
Are nondihydropyridine calcium channel blockers safe and effective for acute rate control in patients with atrial fibrillation with rapid ventricular response and comorbid HFrEF?
This review challenges the extrapolation of chronic NDCCB contraindications to the acute setting, suggesting diltiazem may be a reasonable second-line option for acute rate control in AF RVR with HFrEF.
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Challenges extrapolation of chronic NDCCB contraindications to acute AF RVR in HFrEF; leaves open need for prospective trials before practice change.
Montana et al. (2023) conducted a review in Atrial fibrillation with rapid ventricular response and comorbid heart failure with reduced ejection fraction. Nondihydropyridine calcium channel blockers (NDCCBs) vs. Beta blockers was evaluated. Beta blockers are supported as first-line therapy for acute rate control in AF RVR with HFrEF, with diltiazem as a reasonable second-line option despite limited data.
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