Podcast 773: Atrial Fibrillation Medications

<p><strong>Contributor: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Atrial fibrillation is an irregular heart rhythm that sometimes requires rate control in setting of rapid ventricular response (RVR)</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Calcium channel blocker and beta blockers are the most frequently used medications to block the AV node and slow down the heart rate in atrial fibrillation with RVR</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">If a patient is on one of these agents at home, the IV form should be used first</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Recent systematic review and meta-analysis found 3 trials addressing which medication to use to control heart rate in atrial fibrillation with RVR with a total of 150 patients</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Found diltiazem, a CCB, was 4x more likely to reduce heart rate than metoprolol</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">50% of patients had a normal heart rate at 21 minutes with diltiazem versus 22% in those who received metoprolol</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Both agents had a similar decrease in blood pressure after administration</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Jafri SH, Xu J, Warsi I, Cerecedo-Lopez CD. Diltiazem versus metoprolol for the management of atrial fibrillation: A systematic review and meta-analysis. Am J Emerg Med. 2021 Oct;48:323-327. doi: 10.1016/j.ajem.2021.06.053. Epub 2021 Jun 30. PMID: 34274577.</span></p> <p><em><span style="font-weight: 400;">Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD</span></em></p> <p> </p> <p><span style="font