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Review
. 2024 Mar 20;16(3):e56560.
doi: 10.7759/cureus.56560. eCollection 2024 Mar.

Comparison of the Effectiveness and Safety of Metoprolol and Diltiazem in Atrial Fibrillation With Rapid Ventricular Rate Patients: A Systematic Review and Meta-Analysis

Abshiro H Mayow  1 , Tanya Sinha  2 , Mansoor Ahmad  3 , Ye Kyaw Myint  4 , Samyuktha Balaji  5 , Sandipkumar S Chaudhari  6   7 , Divine Besong Arrey Agbor  8 , Areeba Khan  9
Affiliations
Review

Comparison of the Effectiveness and Safety of Metoprolol and Diltiazem in Atrial Fibrillation With Rapid Ventricular Rate Patients: A Systematic Review and Meta-Analysis

Abshiro H Mayow et al. Cureus. .

Abstract

This study aims to assess the association between intravenous diltiazem and metoprolol in rate control for atrial fibrillation (AF) patients with rapid ventricular rate, focusing on rate control efficacy and hemodynamic adverse events. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, electronic searches were conducted in Embase, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) until February 20, 2024. The primary outcome was achieving ventricular rate control < 110/min. Secondary outcomes included new hypotension (systolic blood pressure < 90 mm Hg) and bradycardia (heart rate < 60/min). Nineteen studies (three randomized controlled trials and 16 observational studies) were included in this meta-analysis. Pooled analysis showed intravenous metoprolol resulted in a 39% lower rate control attainment compared to diltiazem (OR: 0.61; 95% CI: 0.44 to 0.84; p = 0.002). There were no significant differences in bradycardia (OR: 0.51; 95% CI: 0.22 to 1.22; p = 0.13) or hypotension risk (OR: 1.08; 95% CI: 0.72 to 1.61; p = 0.72) between the two groups. Intravenous diltiazem demonstrated superior rate control efficacy compared to metoprolol in AF patients with rapid ventricular rate. However, no significant differences were observed in safety outcomes, namely, bradycardia and hypotension.

Keywords: atrial fibrillation; diltiazem; meta-analysis; metoprolol; rate control.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flowchart of study selection
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2. Comparison of achievement of rate control target
Sources: References [10-27].
Figure 3
Figure 3. Comparison of risk of bradycardia
Sources: References [9,10,13-15,20-22].
Figure 4
Figure 4. Comparison of risk of hypotension
Sources: References [9,10,12-17,19-22,24,27].
Figure 5
Figure 5. Comparison of achievement of rate control target in patients with HFrEF
HFrEF: heart failure with reduced ejection fraction. Sources: References [10,18,19,21].
See this image and copyright information in PMC

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