Publication date: Available online 7 January 2016
Source:The American Journal of Emergency Medicine
Author(s): Patricia Kuang, Nathan D. Mah, Cassie A. Barton, Andrea J. Miura, Laura R. Tanas, Ran Ran
Study ObjectiveTo evaluate the difference in ventricular rate control using an intravenous (IV) metoprolol regimen commonly used in clinical practice in patients receiving chronic beta-blocker therapy compared to patients considered beta-blocker naïve admitted to the emergency department (ED) for atrial fibrillation (AF) with rapid ventricular rate (RVR).MethodsA single-center retrospective cohort study of adult ED patients who were admitted with a rapid ventricular rate of 120 beats per minute (bpm) or greater and treated with IV metoprolol was performed. Rate control was defined as either a decrease in ventricular rate to less than 100 bpm or a 20% decrease in heart rate to less than 120 bpm after metoprolol administration. Patient demographics, differences in length of stay and adverse events were recorded.ResultsA total of 398 patients were included in the study, with 79.4% (n=316) receiving chronic beta-blocker therapy. Patients considered to be beta-blocker naïve were more likely to achieve successful rate control with IV metoprolol compared to patients on chronic beta-blocker therapy (56.1% versus 42.4%, p = 0.03). Beta-blocker naïve status was associated with a shorter length of stay in comparison to patients receiving chronic beta-blocker therapy (1.79 days versus 2.64 days, p <0.01).ConclusionIntravenous metoprolol for the treatment of AF with RVR was associated with a higher treatment response in patients considered beta-blocker naïve compared to patients receiving chronic beta-blocker therapy.
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