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Titolo:
The use of diltiazem for treating rapid atrial fibrillation in the out-of-hospital setting
Autore:
Wang, HE; OConnor, RE; Megargel, RE; Schnyder, ME; Morrison, DM; Barnes, TA; Fitzkee, A;
Indirizzi:
Univ Pittsburgh, Sch Med, Dept Emergency Med, Pittsburgh, PA 15213 USA Univ Pittsburgh Pittsburgh PA USA 15213 ncy Med, Pittsburgh, PA 15213 USA Christiana Care Hlth Syst, Dept Emergency Med, Newark, DE USA Christiana Care Hlth Syst Newark DE USA pt Emergency Med, Newark, DE USA Delaware Off Emergenct Med Serv, Dover, DE USA Delaware Off Emergenct Med Serv Dover DE USA nct Med Serv, Dover, DE USA Sussex Cty Emergency Med Serv, Georgetown, DE USA Sussex Cty Emergency MedServ Georgetown DE USA Serv, Georgetown, DE USA
Titolo Testata:
ANNALS OF EMERGENCY MEDICINE
fascicolo: 1, volume: 37, anno: 2001,
pagine: 38 - 45
SICI:
0196-0644(200101)37:1<38:TUODFT>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
PARKINSON-WHITE SYNDROME; CONGESTIVE-HEART-FAILURE; INTRAVENOUS DILTIAZEM; VENTRICULAR-FIBRILLATION; PHARMACOLOGICAL TREATMENT; CALCIUM-ANTAGONISTS; VERAPAMIL; FLUTTER; MANAGEMENT; DIGOXIN;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
39
Recensione:
Indirizzi per estratti:
Indirizzo: Wang, HE Univ Pittsburgh, Sch Med, Dept Emergency Med, 230 McKee Pl,Suite 400, Pittsburgh, PA 15213 USA Univ Pittsburgh 230 McKee Pl,Suite 400 Pittsburgh PA USA 15213 SA
Citazione:
H.E. Wang et al., "The use of diltiazem for treating rapid atrial fibrillation in the out-of-hospital setting", ANN EMERG M, 37(1), 2001, pp. 38-45

Abstract

Study objective: We sought to evaluate the use of intravenous diltiazem for treatment of rapid atrial fibrillation or flutter (RAF) in the out-of-hospital setting. Methods: This study is a retrospective review of data with historical control subjects. Data were drawn from out-of-hospital patients reported to a statewide paramedic system who presented with atrial fibrillation or flutterand a ventricular response rate (VRR) of 150 beats/min or greater. The intervention (diltiazem) group included patients who received diltiazem duringa 9-month period in 1999. The control group included patients from 1998 who did not receive diltiazem. Patients who were intubated or underwent cardioversion were omitted. Therapeutic response was defined as the occurrence of change to sinus rhythm, reduction of VRR to 100 beats/min or less, or reduction of baseline VRR by 20% or greater. Data were analyzed by using the chi (2) test, the Student's t test, and odds ratios (ORs). A Bonferroni adjusted P value of .005 was used to define statistical significance. Results: Forty-three patients receiving diltiazem and 27 control subjects were included in the study. The mean total diltiazem dose was 19.8 mg (95% confidence interval 17.8 to 21.8). The diltiazem and control groups did notsignificantly differ with respect to age; sex; history of atrial fibrillation; prior use of digitalis, P-blockers, or calcium channel blockers; concurrent out-of-hospital therapies; or baseline VRR or systolic blood pressure(P=.09 to 1.00). The difference in VRR reduction between the diltiazem andcontrol groups was 38 beats/min (95% confidence interval 24 to 52); this difference was statistically significant (P<.001). The mean percentage reduction of VRR in the diltiazem group was -33.1%. The difference in systolic blood pressure change between the diltiazem and control groups was not statistically significant (P=.17). The diltiazem group had a higher prevalence of achieving VRR reduction to 200 beats/min.or less than did the control group (OR 22.6; P<.001), of achieving a VRR reduction of 20% or greater (OR 19.3; P<.001), and of achieving overall therapeutic response (OR 19.3; P<.001). Few changed to sinus rhythm in either group (estimated OR 6.3; P=.15). No patients in the diltiazem group required treatment for hypotension, endotracheal intubation, resuscitation from cardiac arrest, or emergency treatment of unstable dysrhythmias. Conclusion: The effects of diltiazem on RAF can be appreciated within the constraints of the out-of-hospital environment. Diltiazem should be considered as a viable field therapy for rate control of RAF.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 06/04/20 alle ore 21:40:55