Atrial Fibrillation RVR - Medications
Diltiazem
 ...
490
Description

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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Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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