Key result
Intravenous diltiazem significantly reduced the spontaneous termination of pacing-induced atrial fibrillation compared to placebo (23% vs 77%, P=0.01) and esmolol (67%, P<0.05).
Why the study?
Does intravenous diltiazem or esmolol alter the cycle length and spontaneous conversion rate of pacing-induced atrial fibrillation in adults without structural heart disease?
RCT (n=41)
Does intravenous diltiazem or esmolol alter the cycle length and spontaneous conversion rate of pacing-induced atrial fibrillation in adults without structural heart disease?
Intravenous diltiazem shortens atrial fibrillation cycle length and reduces the probability of spontaneous conversion, suggesting its use for acute rate control may unwittingly prolong recent-onset atrial fibrillation.
Answers are grounded in this paper and cite their sources.
Diltiazem may prolong induced AF duration; hypothesis-generating and should not yet change acute treatment practice.
BACKGROUND: Calcium channel blocking agents have been shown to prolong the duration of atrial fibrillation. This study compared the effects of intravenous diltiazem and esmolol on the cycle length and conversion rate of pacing-induced atrial fibrillation. METHODS AND RESULTS: In 41 adults without structural heart disease, atrial fibrillation was induced by rapid atrial pacing. After 3 minutes, either diltiazem (n = 13), esmolol (n = 15), or saline (n = 13) was infused. In the diltiazem group, the atrial fibrillation cycle length shortened by a mean of 43 milliseconds and became significantly shorter than in the control group, while the atrial fibrillation cycle length in the esmolol group did not change. Spontaneous termination of atrial fibrillation occurred significantly less often in the diltiazem group (23%) than in the esmolol (67%, P < 0.05) or placebo groups (77%, P = 0.01). CONCLUSIONS: Intravenous diltiazem shortens the atrial fibrillation cycle length and lowers the probability of spontaneous conversion of recent-onset atrial fibrillation to sinus rhythm. These results suggest that the use of diltiazem for acute rate control may unwittingly prolong the duration of recent-onset atrial fibrillation.
No takes yet. Share an insight, caveat, or question.
Sticherling et al. (2002) conducted an RCT in Pacing-induced atrial fibrillation (n=41). Intravenous diltiazem and esmolol vs. Saline (placebo) was evaluated on Spontaneous termination of atrial fibrillation (p=0.01). Intravenous diltiazem significantly reduced the spontaneous termination of pacing-induced atrial fibrillation compared to placebo (23% vs 77%, P=0.01) and esmolol (67%, P<0.05).
Synapse has enriched 10 related papers. Consider them for comparative context: