Does amiodarone improve time to ventricular rate control compared to digoxin in critically ill adults with atrial fibrillation and rapid ventricular rate?
Amiodarone and digoxin are similarly effective for initial rate control in critically ill patients with rapid atrial fibrillation, though amiodarone may be more effective in patients requiring catecholamines.
Background: In critically ill patients with atrial fibrillation (AF) with rapid ventricular rate (RVR), first-line agents may be due to hemodynamically unfavorable. Amiodarone and digoxin are alternatives, however, there is a paucity of literature comparing their effectiveness. This study compared the effectiveness of these agents in critically ill patients in AF with RVR. Methods: This retrospective chart review included critically ill adults between June 2014 and December 2016 who experienced AF with RVR (HR ≥110 bpm) and were initiated on digoxin or amiodarone. The primary endpoint was time until ventricular rate control (HR <110 bpm) within 24 hours. Secondary endpoints included maintenance of target heart rate, time to sinus rhythm conversion, need for rescue therapy, ICU length of stay, 30-day in-hospital mortality, and safety. Results: Thirty-two patients were included in the amiodarone group and 54 patients in the digoxin group. There was no statistically significant difference in time to ventricular rate control between amiodarone and digoxin 4 (IQR, 2–4) vs. 5.5 h (IQR, 2–11), P=0.46, and both agents were similarly efficacious in maintaining rate control (74% vs. 78%, P=0.18). Digoxin was less effective in patients requiring catecholamines in lowering heart rate at 24 hours (107±12 vs. 95±16 bpm, P=0.02) Conclusions: Both groups were similar in time to rate control and rate control at 24 hours. Digoxin was less effective at lowering HR in patients requiring catecholamines.
Gritsenko et al. (2018) studied this question.