Atrial Fibrillation RVR - Medications
Diltiazem
• Preferred in patients with chronic lung such as Asthma and COPD
Metoprolol
• Particularly useful when A-fib associated with exercise, after acute MI, or with thyrotoxicosis
• Long-term β-blocker improves patient survival (CCB may worsen outcomes), thus starting a β-blocker upon discharge, strongly consider using the agent for rate control also.
Esmolol
• Use if unsure whether patient will tolerate a β-blocker since the duration of action is only 10 minutes
Digoxin
• Consider as initial therapy for patients with LV dysfunction who:
- Do not achieve rate control targets on β-blockers alone
- Cannot tolerate addition of or increased doses of β-blocker due to decompensated CHF
- Would have digoxin added anyway to improve CHF symptoms independent of A-fib
• Consider as initial therapy in patients with severe hypotension
• Consider as 2nd agent in patients in whom IV BB or IV CCB has failed to control their rate
• May take up to 6-8 hours to work
Amiodarone
• Consider for patients with decompensated heart failure or those with accessory pathways
• 2nd-line agent for chronic rate control when beta-blockers and calcium-channel blockers, alone, combined, or when used with digoxin, are ineffective
Magnesium sulfate
• IV MgSO4 appears to have a synergistic effect when combined with other AV nodal blockers resulting in improved rate control.
• Given in conjunction with beta-blockers and calcium-channel blockers.
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