AzTrials
AzTrials

Heart Rate and Rhythm DisordersPhase 4DiMENCT01914926

Comparison of Diltiazem and Metoprolol in the Management of Acute Atrial Fibrillation or Atrial Flutter

A Phase 4 study testing Metoprolol and Diltiazem in people with Heart Rate and Rhythm Disorders, run by Antonios Likourezos at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Acute atrial fibrillation is the most common sustained, clinically significant dysrhythmia encountered in the emergency department (ED) and the most common dysrhythmia treated by emergency physicians. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Heart Rate and Rhythm Disorders
What is being tested?
Metoprolol and Diltiazem
Could I receive a placebo?
No, everyone receives an active treatment
How many people
54 participants
Where
1 siteUnited States
Study dates
Jun 2009to Nov 2010
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Eligible patients had to have a 12-lead electrocardiogram (ECG) showing atrial fibrillation or atrial flutter with a ventricular rate of greater than or equal to 120 beats per minute and a systolic blood pressure of greater than or equal to 90 mmHg.

Who cannot join

  • Patients were excluded if they had any of the following:
  • a systolic blood pressure <90 mmHg, ventricular rate greater than or equal to 220 beats per minute,
  • QRS >0.100 seconds, 2nd or 3rd degree atrioventricular (AV) block,
  • temperature >38.0 ˚C,
  • acute ST elevation myocardial infarction,
  • known history of New York Heart Association Class IV heart failure or
Show all 14Show fewer
  • active wheezing with a history of bronchial asthma or COPD.
  • In addition, patients were excluded if there was:
  • prehospital administration of diltiazem or any other AV nodal blockading agent,
  • a history of cocaine or methamphetamine use in the previous 24 hours prior to arrival,
  • a history of allergic reaction to diltiazem or metoprolol,
  • a history of sick sinus or pre-excitation syndromes,
  • a history of anemia with hemoglobin <11.0 g/dl,
  • pregnancy or breastfeeding.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Maimonides Medical Center

    Brooklyn, New York, 11219

Other trials in United States

About this study

Official title: DiME Study: Comparison of Diltiazem and Metoprolol in the Management of Acute Atrial Fibrillation or Atrial Flutter With Rapid Ventricular Response: A Prospective Randomized and Double-Blinded Non-Inferiority Trial of Safety and Efficacy

Acute atrial fibrillation is the most common sustained, clinically significant dysrhythmia encountered in the emergency department (ED) and the most common dysrhythmia treated by emergency physicians. Atrial flutter is less common than atrial fibrillation but its management in the ED is very similar, and the majority of patients with atrial flutter also have atrial fibrillation. Symptomatic relief and ventricular rate control are generally the primary therapeutic objectives in the ED management of acute atrial fibrillation and flutter (AFF). The need for swift, appropriate action by the emergency physician is highlighted by the fact that up to 18% of patients with AFF develop potentially life-threatening complications such as congestive heart failure, hypotension, ventricular ectopy, respiratory failure, angina and myocardial infarction.

Both beta-blocking agents and calcium channel blockers are commonly used to treat AFF in the ED. Metoprolol is the most commonly used beta-blocker; and diltiazem is the most frequently used calcium channel antagonist.[8] Diltiazem was released by the FDA for treatment of AFF in 1992. Shreck et al. were the first to demonstrate both the efficacy of diltiazem in the ED management of AFF with rapid rate and its clear superiority over the previously most commonly used pharmacologic agent, digoxin.

To date, only one prospective, randomized trial has compared the effectiveness of a calcium channel blocker (diltiazem) with a beta-blocker (metoprolol) for rate control of AFF in the ED. Despite the relatively small sample size (n=20 in each group) the authors concluded that both pharmacologic agents were similarly effective. In order to test this finding, the investigators conducted a prospective comparison of metoprolol and diltiazem for the management of patients presenting to the ED with AFF with rapid ventricular rate.

Read the detailed description

We conducted a prospective, randomized, double-blind study to compare the effectiveness of intravenous metoprolol with that of diltiazem in achieving rate control in adult ED patients with rapid atrial fibrillation or flutter. Approval of the study was obtained from our hospital's institutional review board. All enrolled patients provided written informed consent and HIPAA authorization documentation.

This study was set in the adult ED of Maimonides Medical Center, an urban teaching hospital in Brooklyn, NY with an annual ED census of more than 120,00 patients. A convenience sample of adult patients age 18 or older presenting with a supraventricular tachydysrhythmia were evaluated for enrollment. Eligible patients had to have a 12-lead electrocardiogram (ECG) showing atrial fibrillation or atrial flutter with a ventricular rate of greater than or equal to 120 beats per minute. Data collected included demographics, medical history, vital signs and electrocardiogram findings. All patients were immediately evaluated by the treating physician utilizing ACLS protocols. At the discretion of the treating physician, intravenous adenosine was administered in order to facilitate identification of the underlying supraventricular tachydysrhythmia. All patients were attached to a monitor that displays cardiac rhythm, heart rate, blood pressure and oxygen saturation.

Upon enrollment, patients were randomly assigned, in a 1:1 ratio, to receive diltiazem administered parenterally at a dose of 0.25 mg/kg (to a maximum dose of 30 mg) or metoprolol administered at a dose of 0.15 mg/kg (to a maximum dose of 10 mg). Randomization was performed through the use of a computer-generated randomization list. Pharmacy released the study drug in a locked tackle box coded in number sequence to correspond to that of the computer-generated randomization list, upon which the pharmacist also prepared the study drug in blinded fashion. The study medications were packaged in identical-appearing dispensing kits. Patients who were randomly assigned to diltiazem received a bolus injection in a syringe that appeared identical to that of metoprolol. Admixture and labeling were performed by the pharmacist in the ED and dispensed to the treating nurse for administration. Doses of each study medication were adjusted with normal saline to a total of 10 ml in each syringe to prevent un-blinding. The time at which the first dose was administered was denoted as time zero (baseline). If the primary endpoint was not achieved at time 15 minutes, then a second escalation dose was administered. If the patient had been enrolled in the diltiazem group, the escalation dose was 0.35 mg/kg (to a maximum dose of 30 mg), and for patients enrolled in the metoprolol group, the escalation dose was 0.25 mg/kg (to a maximum dose of 10 mg). As with the initial dose, the escalation dose was prepared by the pharmacist and given to the treating nurse for patient administration in a blinded fashion.

Being tested
Metoprolol, Diltiazem
Keywords
metoprolol, diltiazem, heart rate

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MetoprololDrug

  • DiltiazemDrug

Study groups in NCT01914926
Study groupRoleWhat they receive
Metoprolol Study GroupActive comparatorPatients Receiving metoprolol administered at a dose of 0.15 mg/kg (to a maximum dose of 10 mg)
Receives: Drug: Metoprolol
Diltiazem Study GroupActive comparatorPatients receiving diltiazem administered parenterally at a dose of 0.25 mg/kg (to a maximum dose of 30 mg)
Receives: Drug: Diltiazem

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percent of Patients Reaching Target HR<100bpm Within 30 Minutes

    Percent of patient who reached a HR<100bpm within 30 minutes from baseline.

    Measured: 30 minutes

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Aug 2013 (estimated)
  2. Study startJun 2009
  3. Primary completionNov 2010
  4. Study completionNov 2010

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
54 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01914926
Sponsor's protocol ID
09/01/VA02
Acronym
DiME
Status last verified
May 2014
First submitted
11 Jul 2013
Last updated
15 May 2014
Data monitoring committee
No

Publications

  • Scott PA, Pancioli AM, Davis LA, Frederiksen SM, Eckman J. Prevalence of atrial fibrillation and antithrombotic prophylaxis in emergency department patients. Stroke. 2002 Nov;33(11):2664-9. doi: 10.1161/01.str.0000035260.70403.88.

    PubMed 12411658
  • McDonald AJ, Pelletier AJ, Ellinor PT, Camargo CA Jr. Increasing US emergency department visit rates and subsequent hospital admissions for atrial fibrillation from 1993 to 2004. Ann Emerg Med. 2008 Jan;51(1):58-65. doi: 10.1016/j.annemergmed.2007.03.007. Epub 2007 Apr 27.

    PubMed 17466409
  • Friberg J, Buch P, Scharling H, Gadsbphioll N, Jensen GB. Rising rates of hospital admissions for atrial fibrillation. Epidemiology. 2003 Nov;14(6):666-72. doi: 10.1097/01.ede.0000091649.26364.c0.

    PubMed 14569181
  • Wattigney WA, Mensah GA, Croft JB. Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: implications for primary prevention. Circulation. 2003 Aug 12;108(6):711-6. doi: 10.1161/01.CIR.0000083722.42033.0A. Epub 2003 Jul 28.

    PubMed 12885749
  • Stiell IG, Clement CM, Perry JJ, Vaillancourt C, Symington C, Dickinson G, Birnie D, Green MS. Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter. CJEM. 2010 May;12(3):181-91. doi: 10.1017/s1481803500012227.

    PubMed 20522282
  • Friedman HZ, Goldberg SF, Bonema JD, Cragg DR, Hauser AM. Acute complications associated with new-onset atrial fibrillation. Am J Cardiol. 1991 Feb 15;67(5):437-9. doi: 10.1016/0002-9149(91)90059-t. No abstract available.

    PubMed 1994672
  • Chenoweth J, Diercks DB. Management of atrial fibrillation in the acute setting. Curr Opin Crit Care. 2012 Aug;18(4):333-40. doi: 10.1097/MCC.0b013e328354dc30.

    PubMed 22622515
  • Demircan C, Cikriklar HI, Engindeniz Z, Cebicci H, Atar N, Guler V, Unlu EO, Ozdemir B. Comparison of the effectiveness of intravenous diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation. Emerg Med J. 2005 Jun;22(6):411-4. doi: 10.1136/emj.2003.012047.

    PubMed 15911947
  • Kovacic JC, Moreno P, Nabel EG, Hachinski V, Fuster V. Cellular senescence, vascular disease, and aging: part 2 of a 2-part review: clinical vascular disease in the elderly. Circulation. 2011 May 3;123(17):1900-10. doi: 10.1161/CIRCULATIONAHA.110.009118. No abstract available.

    PubMed 21537006
  • Stiell IG, Macle L; CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: management of recent-onset atrial fibrillation and flutter in the emergency department. Can J Cardiol. 2011 Jan-Feb;27(1):38-46. doi: 10.1016/j.cjca.2010.11.014.

    PubMed 21329861
  • Rogenstein C, Kelly AM, Mason S, Schneider S, Lang E, Clement CM, Stiell IG. An international view of how recent-onset atrial fibrillation is treated in the emergency department. Acad Emerg Med. 2012 Nov;19(11):1255-60. doi: 10.1111/acem.12016.

    PubMed 23167856
  • Maxwell CJ, Hogan DB, Campbell NR, Ebly EM. Nifedipine and mortality risk in the elderly: relevance of drug formulation, dose and duration. Pharmacoepidemiol Drug Saf. 2000 Jan;9(1):11-23. doi: 10.1002/(SICI)1099-1557(200001/02)9:13.0.CO;2-U.

    PubMed 19025798
  • Jollis JG, Simpson RJ Jr, Chowdhury MK, Cascio WE, Crouse JR 3rd, Massing MW, Smith SC Jr. Calcium channel blockers and mortality in elderly patients with myocardial infarction. Arch Intern Med. 1999 Oct 25;159(19):2341-8. doi: 10.1001/archinte.159.19.2341.

    PubMed 10547174

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Metoprolol and Diltiazem in people with Heart Rate and Rhythm Disorders, run by Antonios Likourezos at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 May 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 16 Dec 2013). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percent of Patients Reaching Target HR<100bpm Within 30 Minutes (time frame: 30 minutes). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01914926, which also lists 13 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 May 2014.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in