Conversion of atrial fibrillation to sinus rhythm during treatment with intravenous esmolol or diltiazem: a prospective, randomized comparison

J Cardiovasc Pharmacol Ther. 2007 Sep;12(3):227-31. doi: 10.1177/1074248407303792.


Prior studies have suggested that intravenous diltiazem reduces the probability of spontaneous conversion of atrial fibrillation (AF) to sinus rhythm in the electrophysiology laboratory and in patients with postoperative AF. Whether diltiazem exerts the same effect in patients presenting to the emergency department (ED) with spontaneous AF is unclear. Fifty patients presenting to the ED with new-onset or paroxysmal AF and a rapid ventricular rate (>100 beats per minute) were randomly assigned to receive intravenous diltiazem or esmolol during the first 24 hours of presentation. Conversion to sinus rhythm occurred in 10 patients (42%) in the diltiazem group compared with 10 patients (39%) in the esmolol group (P = 1.0). Diltiazem does not decrease the likelihood of spontaneous conversion of AF to sinus rhythm in the ED setting.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / adverse effects
  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / drug therapy*
  • Calcium Channel Blockers / adverse effects
  • Calcium Channel Blockers / therapeutic use*
  • Diltiazem / adverse effects
  • Diltiazem / therapeutic use*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Propanolamines / adverse effects
  • Propanolamines / therapeutic use*
  • Prospective Studies
  • Treatment Outcome


  • Adrenergic beta-Antagonists
  • Calcium Channel Blockers
  • Propanolamines
  • Diltiazem
  • esmolol