Study on Intravenous Diltiazem vs. Metoprolol

In China, intravenous diltiazem and metoprolol are commonly used for treating atrial fibrillation (AF) with rapid ventricular rate (RVR) in the emergency department (ED). However, the advantages and disadvantages of these drugs cannot be verified. A recent study in the American Journal of Emergency Medicine found that IV diltiazem versus metoprolol has higher efficacy, lower ventricular rate, shorter average onset time, less impact on blood pressure, and no increase in adverse events.

In the study, published in The American Journal of Emergency Medicine, Qingsu Lan, The First Clinical Medical College, Lanzhou University, Lanzhou, China, and colleagues aimed to assess the efficacy and safety of intravenous diltiazem versus metoprolol for AF with RVR.

For this purpose, the researchers systematically searched the online databases. Meta-analysis was performed using weighted mean difference (WMD), relative risk (RR), and 95% confidence interval (CI). Using Review Manager 5.4.1., the researcher performed statistical analysis.

The meta-analysis included seventeen studies involving 1214 patients in nine randomized controlled trials (RCTs) and eight cohort studies. 643 patients were included in the intravenous diltiazem group and 571 patients in the intravenous metoprolol group.

The results of the meta-analysis showed that compared with intravenous metoprolol, intravenous diltiazem was found to have:

• Higher efficacy (RR = 1.11)
• Shorter average onset time (RR = −1.13)
• Less impact on systolic blood pressure (WMD = 3.76)
• Lower ventricular rate (RR = −9.48)
• Diastolic blood pressure (WMD = −1.20)
• No significant difference in adverse events (RR = 0.80) was found between intravenous diltiazem and metoprolol

"Intravenous diltiazem has higher efficacy, shorter average onset time, lower ventricular rate, less impact on blood pressure, and with no increase in adverse events compared to intravenous metoprolol," wrote the researchers.

Reference

The study titled, "Intravenous diltiazem versus metoprolol for atrial fibrillation with rapid ventricular rate: A meta-analysis," is published in The American Journal of Emergency Medicine.

DOI: https://www.sciencedirect.com/science/article/abs/pii/S0735675721008883