Acute Atrial Fibrillation - Initial Options for Rate Control

Diltiazem IV

 •  Rapid onset and rapidly titratable

 •  Easy to transition to oral

 •  Generally considered most effective option for achieving immediate rate control

Diltiazem (Oral)

 •  Easy to directly transition to outpatient regimen

Metoprolol (IV)

 •  Easy to transition to oral metoprolol

 •  Beneficial in HFrEF (long-term)

Esmolol (IV)

 •  Rapid onset and rapidly titratable

 •  NO oral form, so transitioning to outpatient regimen is not as clear as with other options

Amiodarone (IV)

 •  Best acute option for patients with ADHF

 •  Risks conversion to sinus rhythm

 •  IV bolus can cause hypotension

 •  Many toxicities with long-term oral use

Digoxin (IV or PO)

 •  Slowest onset of action

 •  Rate control is most prominent when patient at rest

 •  3rd line agent

 •  Does not cause hypotension



- Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedicalLectures/



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