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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. Metoprolol is the most commonly used beta-blocker; and diltiazem is the most frequently used calcium channel antagonist. 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. 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. 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.

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