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Article: Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation

TitleIntravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation
Authors
KeywordsAmiodarone
Atrial fibrillation
Digoxin
Diltiazem
Ventricular rate control
Issue Date2009
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ccmjournal.org
Citation
Critical Care Medicine, 2009, v. 37 n. 7, p. 2174-2179 How to Cite?
AbstractObjectives: To compare the clinical efficacy of intravenous diltiazem, digoxin, and amiodarone for acute ventricular rate (VR) control in patients with acute symptomatic atrial fibrillation (AF) necessitating hospitalization. Design: Randomized control trial. Setting: Acute emergency medical admission unit in a regional teaching hospital in Hong Kong. Patients: One hundred fifty adult patients with acute AF and rapid VR (>120 bpm). Interventions: Patients were randomly assigned in 1:1:1 ratio to receive intravenous diltiazem, digoxin, or amiodarone for VR control. Measurements and Main Results: The primary end point was sustained VR control (<90 bpm) within 24 hours; the secondary end points included AF symptom improvement and length of hospitalization. At 24 hours, VR control was achieved in 119 of 150 patients (79%). The time to VR control was significantly shorter among patients in the diltiazem group (log-rank test, p < 0.0001) with the percentage of patients who achieved VR control being higher in the diltiazem group (90%) than the digoxin group (74%) and the amiodarone group (74%). The median time to VR control was significantly shorter in the diltiazem group (3 hours, 1-21 hours) compared with the digoxin (6 hours, 3-15 hours, p < 0.001) and amiodarone groups (7 hours, 1-18 hours, p = 0.003). Furthermore, patients in the diltiazem group persistently had the lowest mean VR after the first hour of drug administration compared with the other two groups (p < 0.05). The diltiazem group had the largest reduction in AF symptom frequency score and severity score (p < 0.0001). In addition, length of hospital stay was significantly shorter in the diltiazem group (3.9 ± 1.6 days) compared with digoxin (4.7 ± 2.1 days, p = 0.023) and amiodarone groups (4.7 ± 2.2 days, p = 0.038). Conclusions: As compared with digoxin and amiodarone, intravenous diltiazem was safe and effective in achieving VR control to improve symptoms and to reduce hospital stay in patients with acute AF. Copyright © 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/78529
ISSN
2015 Impact Factor: 7.422
2015 SCImago Journal Rankings: 3.748
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorSiu, CWen_HK
dc.contributor.authorLau, CPen_HK
dc.contributor.authorLee, WLen_HK
dc.contributor.authorLam, KFen_HK
dc.contributor.authorTse, HFen_HK
dc.date.accessioned2010-09-06T07:43:53Z-
dc.date.available2010-09-06T07:43:53Z-
dc.date.issued2009en_HK
dc.identifier.citationCritical Care Medicine, 2009, v. 37 n. 7, p. 2174-2179en_HK
dc.identifier.issn0090-3493en_HK
dc.identifier.urihttp://hdl.handle.net/10722/78529-
dc.description.abstractObjectives: To compare the clinical efficacy of intravenous diltiazem, digoxin, and amiodarone for acute ventricular rate (VR) control in patients with acute symptomatic atrial fibrillation (AF) necessitating hospitalization. Design: Randomized control trial. Setting: Acute emergency medical admission unit in a regional teaching hospital in Hong Kong. Patients: One hundred fifty adult patients with acute AF and rapid VR (>120 bpm). Interventions: Patients were randomly assigned in 1:1:1 ratio to receive intravenous diltiazem, digoxin, or amiodarone for VR control. Measurements and Main Results: The primary end point was sustained VR control (<90 bpm) within 24 hours; the secondary end points included AF symptom improvement and length of hospitalization. At 24 hours, VR control was achieved in 119 of 150 patients (79%). The time to VR control was significantly shorter among patients in the diltiazem group (log-rank test, p < 0.0001) with the percentage of patients who achieved VR control being higher in the diltiazem group (90%) than the digoxin group (74%) and the amiodarone group (74%). The median time to VR control was significantly shorter in the diltiazem group (3 hours, 1-21 hours) compared with the digoxin (6 hours, 3-15 hours, p < 0.001) and amiodarone groups (7 hours, 1-18 hours, p = 0.003). Furthermore, patients in the diltiazem group persistently had the lowest mean VR after the first hour of drug administration compared with the other two groups (p < 0.05). The diltiazem group had the largest reduction in AF symptom frequency score and severity score (p < 0.0001). In addition, length of hospital stay was significantly shorter in the diltiazem group (3.9 ± 1.6 days) compared with digoxin (4.7 ± 2.1 days, p = 0.023) and amiodarone groups (4.7 ± 2.2 days, p = 0.038). Conclusions: As compared with digoxin and amiodarone, intravenous diltiazem was safe and effective in achieving VR control to improve symptoms and to reduce hospital stay in patients with acute AF. Copyright © 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.en_HK
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ccmjournal.orgen_HK
dc.relation.ispartofCritical Care Medicineen_HK
dc.rightsCritical Care Medicine. Copyright © Lippincott Williams & Wilkins.en_HK
dc.subjectAmiodaroneen_HK
dc.subjectAtrial fibrillationen_HK
dc.subjectDigoxinen_HK
dc.subjectDiltiazemen_HK
dc.subjectVentricular rate controlen_HK
dc.subject.meshAgeden_HK
dc.subject.meshAmiodarone - therapeutic useen_HK
dc.subject.meshAnti-Arrhythmia Agents - therapeutic useen_HK
dc.subject.meshAtrial Fibrillation - complications - drug therapy - physiopathologyen_HK
dc.subject.meshCohort Studiesen_HK
dc.subject.meshDigoxin - therapeutic useen_HK
dc.subject.meshDiltiazem - therapeutic useen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshInfusions, Intravenousen_HK
dc.subject.meshLength of Stayen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshTachycardia, Ventricular - etiology - prevention & controlen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titleIntravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillationen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0090-3493&volume=37&issue=7&spage=2174&epage=2179&date=2009&atitle=Intravenous+diltiazem+is+superior+to+intravenous+amiodarone+or+digoxin+for+achieving+ventricular+rate+control+in+patients+with+acute+uncomplicated+atrial+fibrillationen_HK
dc.identifier.emailSiu, CW: cwdsiu@hkucc.hku.hken_HK
dc.identifier.emailLam, KF: hrntlkf@hkucc.hku.hken_HK
dc.identifier.emailTse, HF: hftse@hkucc.hku.hken_HK
dc.identifier.authoritySiu, CW=rp00534en_HK
dc.identifier.authorityLam, KF=rp00718en_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/CCM.0b013e3181a02f56en_HK
dc.identifier.pmid19487941en_HK
dc.identifier.scopuseid_2-s2.0-67649800834en_HK
dc.identifier.hkuros157330en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-67649800834&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume37en_HK
dc.identifier.issue7en_HK
dc.identifier.spage2174en_HK
dc.identifier.epage2179en_HK
dc.identifier.eissn1530-0293-
dc.identifier.isiWOS:000267245200005-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridSiu, CW=7006550690en_HK
dc.identifier.scopusauthoridLau, CP=7401968501en_HK
dc.identifier.scopusauthoridLee, WL=16230746200en_HK
dc.identifier.scopusauthoridLam, KF=8948421200en_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK

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