Atrial Fibrillation

 

Pharmacologic Agents for Control of Ventricular Rate in Atrial Fibrillation

 

Agent

Action

Immediate IV Dose

Usual Oral Maintenance Therapy

Avoid Use, or Caution with Use

Diltiazem

CCB

20mg (or 0.25 mg/kg to 0.35 mg/kg) over 2 min;

+5,10,15 mg/H infusion

120-360 mg/day

WPW, constipation,

Overt CHF

Esmolol

BB

0.5 mg/kg (500mcg/kg)  load over 1 min, then 0.05  mg/kg/min (50 mcg/min)  to 0.3 mg/kg (300 mcg/kg)  per min

IV only

Overt CHF not due to rapid ventricular rate

Metoprolol

BB

5mg every 5 min up to 15 mg total

50-200 mg/day

Bronchospastic lung disease

Overt CHF

Digoxin

Cardiac glycoside

0.5 mg +

0.25 mg in 4-6H +

0.25 mg in 4-6H

0.125-0.5 mg/day

WPW, hypertrophic cardiomyopathy (inotropic effect)