OBJECTIVETo evaluate the efficacy and safety of intravenous esmolol, amiodarone and diltiazem for controlling rapid ventricular rate in patients with atrial fibrillation (AF) during anesthesia period.

METHODSNinety AF patients with rapid atrial ventricular rate (≥ 120 beats/min) in anesthesia period were randomly divided into 3 groups (n = 30 each: group I patients were treated with intravenous esmolol (0.5 mg/kg loading dose within 1 minute followed with infusion of 0.05 mg×kg(-1)×min(-1)); group II patients were treated with intravenous amiodarone (loading dose: 3 mg/kg for 10 minutes, followed with intravenous infusion of 1 mg/min); group III patients were treated with intravenous diltiazem (0.25 mg/kg for 5 minutes). The heart rate, blood pressure, rhythm were recorded before treatment, at 5, 10, 15, 30, 60 and 90 min after treatment. The reacting time, side effects including hypotension, bradycardia, nausea, vomiting, dizziness, etc, were analyzed.

RESULTSThe mean reacting time was significantly shorter in group I (4.3 ± 2.1) min than in group II (19.2 ± 8.5) min and in group III (8.5 ± 3.4) min (P < 0.05). The mean reacting time in group III was significantly shorter than in group II (P < 0.05). The total effective rate were similar among the groups (86.7%, 90.0% and 83.3% with a mean decrease in heart ventricular rate by 42.4%, 42% and 41.9% of the baseline level in group I, group II and group III, respectively). The incidence of total side effect was significantly lower in group II (10%) than in group I (16.7%) and group III (20%, P < 0.05).

CONCLUSIONSIntravenous esmolol, amiodarone and diltiazem are all equally effective and safe on controlling rapid ventricular rate in patients with atrial fibrillation during the anesthesia period. Esmolol use is associated with the shortest mean reacting time and amiodarone use is associated with the lowest total side effect rate in this patient cohort.