16839
document
Calcium chloride before i.v . diltiazem in the management of atrial fibrillation . Diltiazem is commonly used to treat atrial fibrillation or flutter ( AFF ) with rapid ventricular response ( RVR ) . Although it is very effective for rate control , up to an 18 % prevalence of reported diltiazem-induced hypotension [ defined by systolic blood pressure ( SBP ) < 90 mm Hg ] , and a mean of 9.7 % hypotension have been reported from several studies totaling over 450 patients . This hypotension may complicate therapy . Our objective was to determine if calcium chloride ( CaCl ( 2 ) ) pre-treatment would blunt a SBP drop after i.v . diltiazem , while allowing diltiazem to maintain its efficacy . A prospective , randomized , double-blind , placebo-controlled study was conducted . Seventy-eight patients with AFF and a ventricular rate of > /= 120 beats per minute were enrolled . Half received i.v . CaCl ( 2 ) pre-treatment ; the other half received placebo . All patients then received i.v . diltiazem in a standard , weight-based dose . A second dose of CaCl ( 2 ) pre-treatment or placebo and diltiazem was given if clinically indicated for additional rate control . Both CaCl ( 2 ) and placebo pre-treatment groups had equal lowering of heart rate ( p < 0.001 ) . There were no adverse events in the calcium pre-treatment study arm . One patient in the placebo group became paradoxically more tachycardic and apneic after the diltiazem infusion . Although i.v . CaCl ( 2 ) seems to be equally safe compared to placebo as a pre-treatment in the management of AFF with RVR , we were unable to find a statistically significant blunting of SBP drop with CaCl ( 2 ) i.v . pre-treatment . Until further research determines a benefit exists , we can not recommend i.v . CaCl ( 2 ) pre-treatment before diltiazem in the treatment of AFF with RVR .
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Intervention_Pharmacological
Calcium chloride before i.v
16841
Intervention_Pharmacological
diltiazem
16842
Intervention_Pharmacological
Diltiazem
16843
Intervention_Pharmacological
diltiazem-induced
16844
Intervention_Pharmacological
calcium chloride ( CaCl ( 2 ) )
16845
Intervention_Pharmacological
diltiazem
16846
Intervention_Pharmacological
CaCl ( 2 )
16847
Intervention_Control
placebo
16848
Intervention_Pharmacological
diltiazem
16849
Intervention_Pharmacological
placebo
16850
Intervention_Pharmacological
diltiazem
16851
Intervention_Pharmacological
placebo
16852
Intervention_Pharmacological
CaCl ( 2 )
16853
Intervention_Pharmacological
diltiazem
16854
Outcome_Physical
management of atrial fibrillation .
16855
Outcome_Physical
rate control
16856
Outcome_Physical
diltiazem-induced hypotension [ defined by systolic blood pressure ( SBP ) < 90 mm Hg ]
16857
Outcome_Physical
hypotension
16858
Outcome_Physical
hypotension
16859
Outcome_Adverse-effects
SBP drop
16860
Outcome_Physical
heart rate
16861
Outcome_Adverse-effects
adverse events
16862
Outcome_Adverse-effects
tachycardic and apneic
16863
Participant_Condition
atrial fibrillation
16864
Participant_Condition
flutter ( AFF )
16865
Participant_Sample-size
450
16866
Participant_Sample-size
Seventy-eight
16867
Participant_Condition
AFF
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Participant_Sample-size
One