What is the Best Agent for Rate Control of Atrial Fibrillation With Rapid Ventricular Response?

Brit Long, Samuel M. Keim, Michael Gottlieb, Ian G. Stiell

Research output: Contribution to journalComment/debatepeer-review

1 Scopus citations


Background: Atrial fibrillation (AF) is a common dysrhythmia associated with significant morbidity and mortality. Although many patients have stable AF, some patients can present with a rapid ventricular response (RVR). In these patients, it is important to lower their heart rate. However, there are several options available for rate control in the emergency department setting. Clinical Question: What is the most effective agent for rate control for the patient with AF in RVR? Evidence Review: Studies retrieved included two prospective, randomized, double-blind studies and six retrospective cohort studies. These studies provide estimates of the efficacy and safety of calcium channel blockers and β-blockers for rate control in those with AF with RVR. Conclusion: Based upon the available literature, diltiazem likely achieves rate control faster than metoprolol, though both agents seem safe and effective. Clinicians must consider the individual patient, clinical situation, and comorbidities when selecting a medication for rate control.

Original languageEnglish (US)
Pages (from-to)467-476
Number of pages10
JournalJournal of Emergency Medicine
Issue number3
StatePublished - Sep 2022


  • atrial fibrillation
  • calcium channel blocker
  • cardiology
  • rate control
  • β-blocker

ASJC Scopus subject areas

  • Emergency Medicine


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