EFFECTS OF INTRAVENOUS DILTIAZEM ON RAPID ATRIAL-FIBRILLATION ACCOMPANIED BY CONGESTIVE-HEART-FAILURE

Digoxin has long been the standard means for controlling the ventricular response in patients with rapid atrial fibrillation (AF).1 This is particularly true because its positive inotropic effects permit use without regard to left ventricular systolic function. Even when intravenous preparations of digoxin are administered, several hours elapse before a clinically significant reduction in heart rate is achieved. Intravenous diltiazem has been shown to slow AF quickly.2 Although diltiazem has been used in patients with significant left ventricular dysfunction,3 there is still concern about its use in patients with decompensated congestive heart failure (CHF).4 Can diltiazem rapidly control the heart rate in such patients without further impairing left ventricular function? To answer this question, we administered intravenous diltiazem to 9 patients with rapid AF and acute, symptomatic CHF. © 1991.