Evaluation of diltiazem dosing strategies in the management of atrial fibrillation in the emergency department.

OBJECTIVE

To compare the incidence of treatment failure between oral (PO) immediate release (IR) tablet and continuous intravenous infusion (CIVI) diltiazem following an initial loading dose in patients with atrial fibrillation (AF) with rapid ventricular response (RVR).

METHODS

This single center, retrospective cohort study evaluated patients presenting to the emergency department (ED) from July 1, 2022 to June 30, 2022 in AF with RVR who received oral or continuous diltiazem after an initial intravenous loading dose. The primary objective of this study is to identify the percentage of patients with treatment failure four hours after initiation of diltiazem IR PO tablet or continuous IV infusion. Secondary endpoints included hospital length of stay (LOS), ED disposition, and clinically significant hypotension.

RESULTS

Of the 171 patients included, 85 received PO IR diltiazem and 86 received CIVI diltiazem. There was no significant difference in the composite outcome of treatment failure between the PO and CIVI groups (60 % vs 59 %, p = 0.93). Patients who received PO diltiazem were more frequently discharged from the ED (31.8 % vs 4.7 %, p < 0.001). There was no significant difference in hospital LOS (6.6 vs 6.5 days, p = 0.06) or clinically significant hypotension (11.7 % vs 8.1 % p = 0.428).

CONCLUSION

Initiating immediate-release oral diltiazem after an initial IV bolus does not result in more treatment failures than initiating a continuous infusion.