We have all encountered patients with Afib with RVR who require rate control and the question always is…..what drug? Some people prefer CCB like diltiazem while others prefer beta blockers like labetalol.  Is one better than the other?

A recent study published in Academic Emergency Medicine looks at Afib patients who visited one of 24 EDs in Ontario Canada between 2008 and 2009 and rhythm control wasn’t attempted in any of these patients.  Question asked in the study: hospital admission rates after BB or CCB.

Beta blockers: n = 429, 70.9% patients with successful rate control, 40.0% admission

  • Patients that were more likely to receive a BB: already on BB at home, sent from doctor’s office, seen at a teaching hospital

CCB: n = 1210, 66.1% patients with successful rate control, 51.6% admission

  • Patients that were more likely to receive CCB: evidence of heart failure, prior use of CCB, higher presenting HR, seen at highest AF volume EDs

Conclusion: use of BB for rate control was associated with lower rate of hospitalization compared to CCB.  But of course realize the population that ended up receiving CCB vs BB was different and this was a review vs a RCT.


Atzema et al.  Rate-control with beta-blockers versus calcium-channel blockers in the emergency setting: predictors of medication class choice and associated hospitalization.  Acad Emerg Med.  2017 Aug 29.