A comparative study on the efficacy of intravenous diltiazem, amiodarone and cediland in rapid atrial fibrillation

Objective To evaluate the efficacy and safety of intravenous diltiazem,amiodarone and cediland for treatment of rapid ventricular rate in atrial fibrillation.Methods A single-blind,randomized study on 73 patients with rapid atrial fibrillation was conducted by comparing intravenous diltiazem,amiodarone and cediland.25 patients were treated with intravenous diltiazem of the dose on 0.25mg/kg in 20ml solution,and observed for 20 minutes.If there is no effect on a patient,it must be done again.24 patients were treated with intravenous amiodarone of the dose 150mg in 20ml solution in 10 minutes,after that,with intravenous drop in 0.8-1.0mg/min. 24 patients were treated with intravenous cediland of 0.2mg to 0.4mg after diluted as control group,If non-effectiye,it can be given 0.2-0.4mg again,but the total dose was 0.4-1.0mg.Results The total effective rate were 92%,93% and 72% with a mean decrease in heart rate by 35%,33% and 24% of the baseline in th diltiazem, amiodarone and cediland group, respectively, while mean time response to the bolus was (7.9±3.7), (14.1±8. 7) and(33.1±10.3)minutes,respectively.Of the 25 patients treated with diltiazem, 1 patient restored to sinus rhythm, 3 patients developed asymptomatic hypotension and 1 patient had sinus bradycardia. Of the 24 patients treated with amiodarone ,4 patients restored to sinus rhythm, 1 patient had sinus bradycardia, Of the 24 patients treated with cediland, 1 patient restored to sinus rhythm and 1 patient developed asymptomatic hypotension. All events were resolved without pharmacologic treatment. No patient developed worsening of congestive heart failure due to diltiazem, amiodarone and cediland.Conclusions Compared with cediland,both diltiazem and amiodarone are safe and effective in acutely slowing of rapid ventricular rate in patients with atrial fibrillation .but diltiazem is more rapid and amiodarone is relatively safe.