Aim To evaluate the efficacy and safety of intravenous diltiazem and metoprolol for treatment of rapid ventricular rate in elderly heart failure (HF) patients with rapid atrial fibrillation. Methods A single-blind, randomized study on 72 elderly HF patients with rapid atrial fibrillation was conducted by comparing intravenous diltiazem and metoprolol. Results The efficacy was 94.6% in the diltiazem group,and the ventricular rate decreased from 149±26 bpm to 97±19 bpm, with a mean decrease by 35% 120 min after treatment;Simultaneously, the efficacacy was 97.1% in the metoprolol group,and the ventricular rate decreased from 150±27 bpm to 95±18 bpm, with a mean decrease by 35%. 3 and 2 patients developed asymptomatic hypotension respectively. No patient developed worsening of HF due to diltiazem, but one patient developed worsening of HF in metoprolol group. Conclusions Diltiazem and metoprolol are all efficacious and relatively safe to control the rapid ventricular rate in elderly HF patients with rapid atrial fibrillation.