Am J Emerg Med

Metoprolol vs. diltiazem for afib: Systematic review examines safety outcomes

February 4, 2025

Study details: This systematic review and meta-analysis evaluated the safety profiles of metoprolol and diltiazem in treating afib with rapid ventricular rate (RVR). The analysis included a total of 13 studies including 1,660 patients, 53% treated with metoprolol and 47% treated with diltiazem.

Results: The overall rate of adverse events (AEs) was 26% lower with metoprolol compared with diltiazem (risk ratio [RR], 0.74; 95 % confidence interval [CI], 0.56–0.98, p = 0.034). Patients with higher initial heart rates experienced higher rates of AEs. However, no between-group difference was found with respect to rates of bradycardia (RR, 0.44; 95 % CI, 0.15–1.30, p = 0.14) or hypotension (RR, 0.80, 95 % CI, 0.61–1.04, p = 0.10).

Clinical impact: Metoprolol may be a safer first-line option for managing afib with RVR in emergency settings. Clinicians should consider the risk profiles of these medications when making treatment decisions, potentially favoring metoprolol to minimize adverse events.

Source:

Hintze TD, et al. (2024, December 27). Am J Emerg Med. Metoprolol vs diltiazem for atrial fibrillation with rapid ventricular rate: Systematic review and meta-analysis of adverse events. https://pubmed.ncbi.nlm.nih.gov/39764905/