Abstract 14066: Control of Atrial Fibrillation With Short vs Long Duration of Continuous Intravenous Diltiazem

Abstract

Introduction: Continuous intravenous (IV) diltiazem is one of the options for urgent management of atrial fibrillation with rapid ventricular response (RVR). This study assesses the clinical outcomes of utilizing IV diltiazem for less than or greater than 24 hours. Methods: A retrospective chart-review of patients receiving continuous IV diltiazem between January 1, 2017 and December 31, 2018 where adult patients were included if they had atrial fibrillation with RVR and were treated with continuous IV diltiazem. Exclusion criteria included initiation of IV diltiazem in the ICU, strict nothing by mouth, only a bolus of IV diltiazem used, no conversion to oral rate controlling agent following discontinuation of IV diltiazem, and if pregnant. Infusions lasting >24 hours and <24 hours were compared. Primary objective was to evaluate duration in goal heart rate for the first 48 hours after conversion to PO diltiazem. Secondary outcomes included length of hospitalization, ICU transfer, 30-day readmission, and development of cardiovascular events including stroke, myocardial infarction, or cardiovascular death. Results: 146 out of 251 patients met inclusion criteria. 75.3% of patients maintained a goal heart rate (less than 110bpm) for at least 80% of the 48 hours after conversion to oral diltiazem in < 24 hours group compared to only 59% (p =0.037). The <24 hours group had more patients in heart rate goal for >85% of 48 hours after conversion to oral diltiazem compared to the >24 hours group (p=0.03). Diltiazem drips used for >24 hours had a higher percentage of ICU transfers (p = 0.035) and longer hospitalization (p = 0.001). There were no differences regarding major adverse cardiovascular events and readmission rates. Conclusions: Diltiazem drip use for <24 hours was associated with greater time spent in goal heart rate as well as a lower rate of ICU transfers and shorter hospitalization when compared to drips used > 24 hours.