Atrial fibrillation with rapid ventricular response (AF/RVR) is a common ED presentation. Digoxin was the primary treatment for control of the ventricular response to AF . . .
Atrial fibrillation with rapid ventricular response (AF/RVR) is a common ED presentation. Digoxin was the primary treatment for control of the ventricular response to AF for more than 200 years, until 1992, when intravenous diltiazem was introduced. Diltiazem provides a faster onset of action and a wider therapeutic index. Recent reports that the combination of digoxin and esmolol provides more rapid and efficient rate control than either agent individually led these authors to speculate that the combination of digoxin and diltiazem might have similar efficacy.
They randomized 52 patients to receive either IV diltiazem alone or diltiazem plus IV digoxin. The diltiazem-alone dosage was a bolus of 0.25 mg/kg administered over 2 minutes, follow…