And the question is: Metoprolol vs. Diltiazem for atrial fibrillation?
The more you explore this topic, the more fascinating and nuanced it becomes. When I wrote a chapter on this for Short Stay Management of Atrial Fibrillation, I initially thought we had thoroughly reviewed the evidence. However, during our later systematic review and meta-analysis, we examined the data from a completely different perspective. Annals of Emergency Medicine even published a “Controversies” section highlighting the ongoing debate around this issue. Ultimately, as much as you study the literature, the decision often comes down to your clinical style and comfort—whether you prefer a calcium channel blocker or a beta blocker, both of which have their place depending on the patient and the clinical context.