Atrial Fibrillation With Rapid Ventricular Response

The goal of this clinical trial is to learn whether intravenous verapamil or intravenous metoprolol controls heart rate more effectively in adult patients who arrive at the emergency department with atrial fibrillation and a fast heart rate (rapid ventricular response), but who are otherwise medically stable. Atrial fibrillation with a rapid heart rate is a common emergency, and doctors currently choose between these two standard medicines based on personal preference rather than strong local evidence, since there is limited research on this comparison in Pakistani patients. The main questions this study aims to answer are: Does a higher proportion of patients reach a target heart rate of less than 110 beats per minute within 30 minutes with verapamil compared to metoprolol? Which medicine controls the heart rate faster, on average? Are there differences in side effects (such as low blood pressure, slow heart rate, or breathing problems) between the two medicines? Researchers will compare a group of patients receiving verapamil to a group receiving metoprolol to see if one medicine controls the heart rate faster and more safely than the other. Participants will: 1. Receive either verapamil or metoprolol through an IV, with the dose given according to standard protocols 2. Have their heart rate, blood pressure, and oxygen levels monitored continuously for 30 minutes after the medicine is given 3. Be observed for any side effects during this monitoring period Both medicines used in this study are already standard, guideline-recommended treatments for this condition, so participation will not change or delay the medical care patients would normally receive.

The purpose of this retrospective study is to evaluate the clinical performance of SMD-RVECG, an artificial intelligence-based medical device software that analyzes single-lead electrocardiogram data to predict the risk of atrial fibrillation with rapid ventricular response occurring within 2 hours. A total of 348 eligible electrocardiogram datasets collected through VitalDB at Seoul National University Hospital will be included. Atrial fibrillation with rapid ventricular response is defined in this study as atrial fibrillation accompanied by an average heart rate of 110 beats per minute or greater for at least 30 seconds. Eligible datasets will be classified as positive or negative for atrial fibrillation with rapid ventricular response. Two qualified physicians blinded to the software results will review the electrocardiogram data and relevant medical records to establish the reference-standard classification. The blinded electrocardiogram datasets will then be analyzed using SMD-RVECG, and the software-generated predictions will be compared with the reference standard to evaluate clinical performance.

INTRODUCTION: The study focuses on comparing the effectiveness of oral Bisoprolol, a beta-1 adrenergic receptor blocker, against intravenous Diltiazem, a calcium channel blocker, in treating rapid atrial fibrillation or flutter with rapid ventricular response in an emergency setting. This research aims to fill the gap in empirical evidence regarding the use of oral Bisoprolol for these conditions, potentially offering a convenient, evidence-based alternative for patient management in emergency departments where established protocols are lacking. METHOD: This study is a randomized controlled trial targeting patients who present to the emergency room with symptomatic atrial fibrillation or flutter and rapid ventricular response requiring intervention. Participants will be split into two groups and undergo continuous monitoring of vital signs and regular electrocardiograms to ensure safety and document any adverse effects. The primary focus is on patient safety while evaluating the efficacy of the treatments. AIM: Evaluate the efficacy and safety of oral bisoprolol in treating atrial fibrillation or atrial flutter with rapid ventricular response in an emergency department setting. PRIMARY OJECTIVES: The primary efficacy outcome will be evaluated by achieving a HR\<110 beats per minute or a decrease ≥20% of baseline HR at 60 minutes. The primary safety outcome measures are HR \< 60 bpm and SBP \< 95 mm Hg. SECONDARY OBJECTIVES: The use of Rescue medication, proportion of patients who required hospitalization, worsening of heart failure or pulmonary oedema, side effect of medication ( dizziness, headaches, gastrointestinal symptoms) PATEINT POPULATION: Adults (18 and older) presenting to the emergency department at Sultan Qaboos University Hospital with symptomatic atrial fibrillation or atrial flutter with rapid ventricular response requiring treatment. INTERVENTION: A single oral dose of 5 mg Bisoprolol (maximum dose of 5 mg) or a single intravenous dose of Diltiazem at 0.25 mg/kg (to a maximum dose of 30 mg). CLINICAL MEASURMENT: Heart rate recorded every 15 minutes up to the 90-minute mark, with a 12-lead ECG performed every 30 minutes. OUTCOME: For therapy to be considered effective, patients must achieve a ventricular rate ≤110/min or experience a drop-in ventricular rate of at least 20% at 60 minutes.