Esmolol Compared with Amiodarone in the Treatment of Recent-Onset Atrial Fibrillation (RAF): An Emergency Medicine External Validity Study.

Abstract

Recent-onset atrial fibrillation (RAF) is the most frequent supraventricular dysrhythmia in emergency medicine. Severely compromised patients require acute treatment with injectable drugs OBJECTIVE: The main purpose of this external validity study was to compare the short-term efficacy of esmolol with that of amiodarone to treat severe RAF in an emergency setting. This retrospective survey was conducted in mobile intensive care units by analyzing patient records between 2002 and 2013. We included RAF with (one or more) severity factors including: clinical shock, angina pectoris, ST shift, and very rapid ventricular rate. A blind matching procedure was used to constitute esmolol group (n=100) and amiodarone group (n=200), with similar profiles for age, gender, initial blood pressure, heart rate, severity factors, and treatment delay. The main outcome measure was the percentage of patients with a ventricular rate control defined as heart frequency ≤ 100 beats/min. More stringent (rhythm control) and more humble indicators (20% heart rate reduction) were analyzed at from 10 to 120min after treatment initiation. Patient characteristics were comparable for both groups: age 66±16years, male 71%, treatment delay < 1h 36%, 1-2h 29%, > 2h 35%, chest pain 61%, ST shift 62%, ventricular rate 154±26 beats/min, and blood pressure 126/73mm Hg. The superiority of esmolol was significant at 40min (64% rate control with esmolol vs. 25% with amiodarone) and for all indicators from 10 to 120min after treatment onset. In "real life emergency medicine," esmolol is better than amiodarone in the treatment of RAF.