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Safety of Intravenous Diltiazem in Reduced Ejection Fraction Heart Failure with Rapid Atrial Fibrillation

Clinical Drug Investigation volume 38, pages 503–508 (2018)Cite this article

Abstract

Background and Objective

Diltiazem is a nondihydropyridine calcium channel blocker that is used to control rapid ventricular response in patients who have atrial fibrillation or flutter. Diltiazem has a negative inotropic effect and may cause hemodynamic decompensation in patients with reduced ejection fraction. This study evaluated outcomes in patients who had low ejection fraction and were treated with diltiazem.

Methods

This was a retrospective chart review in 635 patients who were hospitalized because of rapid atrial fibrillation and who were treated with intravenous diltiazem. Outcomes were evaluated for patients in two groups based on ejection fraction (EF): normal (EF ≥ 50%) and low EF (EF < 50%).

Results

There were no differences in frequency of hypotension, intensive care unit transfer, or in-hospital mortality between the two groups. There was a significantly higher frequency of acute kidney injury within 48 h after starting diltiazem in patients who had low (16 patients [10%]) compared with normal EF (17 patients [3.6%] P = 0.002).

Conclusions

Intravenous diltiazem in patients who have decreased EF may be associated with increased risk of acute kidney injury, but not increased risk of hypotension, intensive care unit transfer, or in-hospital mortality.

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Affiliations

  1. William Beaumont School of Medicine, Oakland University, Troy, MI, USA

    Mohamad Badr Jandali

  2. Department of Internal Medicine, Beaumont Health System, 44201 Dequindre Rd, Troy, MI, 48085, USA

    Mohamad Badr Jandali

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  1. Mohamad Badr Jandali
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Correspondence to Mohamad Badr Jandali.

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The Institutional Review Board approved this project before the start of any data gathering.

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The author declares no conflict of interest.

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Jandali, M.B. Safety of Intravenous Diltiazem in Reduced Ejection Fraction Heart Failure with Rapid Atrial Fibrillation. Clin Drug Investig 38, 503–508 (2018). https://doi.org/10.1007/s40261-018-0631-7

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  • DOI: https://doi.org/10.1007/s40261-018-0631-7