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Digoxin has long been the standard means for controlling the ventricular response in patients with rapid atrial fibrillation (AF). 1 This is particularly true because its positive inotropic effects permit use without regard to left ventricular systolic function. Even when intravenous preparations of digoxin are administered, several hours elapse before a clinically significant reduction in heart rate is achieved. Intravenous diltiazem has been shown to slow AF quickly. 2 Although diltiazem has been used in patients with significant left ventricular dysfunction, 3 there is still concern about its use in patients with decompensated congestive heart failure (CHF). 4 Can diltiazem rapidly control the heart rate in such patients without further impairing left ventricular function? To answer this question, we administered intravenous diltiazem to 9 patients with rapid AF and acute, symptomatic CHF.