Amiodarone vs. digoxin for ventricular-rate control in patients with atrial fibrillation at the emergency department

Abstract

© 2020 JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND. Objective: To compare an efficacy of amiodarone and digoxin in terms of rate control in patients with atrial fibrillation (AF) with rapid ventricular response at the emergency department. Materials and Methods: The present study was a descriptive, retrospective study conducted at the University Hospital. The inclusion criteria were age over 18 years, presenting at the emergency room with AF and heart rate over 120 beats/min, and systolic blood pressure over 90 mmHg. There were four clinical outcomes examined including successful heart rate control, heart rate difference, treatment duration, and vital signs after treatment. Results: During the study period, there were 147 patients who met the study criteria. Of those, 85 (57.83%) received amiodarone treatment. Regarding treatment outcomes, the amiodarone group had a significantly higher proportion of patients who achieved successful heart-rate control rate than the digoxin group (89.41% vs. 51.61%; p<0.001). Patients who received amiodarone were 1.4-times more likely to achieve a normal heart rate than digoxin (95% CI = 1.2 to 1.7 times, p-value <0.001). The two groups were comparable in terms of the other outcomes. Conclusion: Intravenous amiodarone was able to control ventricular rate in AF patients better than digoxin. In settings in which access to intravenous antiarrhythmic agents is limited, amiodarone may be a potential alternative agent.