Intravenous Therapy for Rate Control in Atrial Fibrillation, Atrial Flutter and Atrial Tachycardia

Intravenous Therapy for Rate Control in Atrial Fibrillation, Atrial Flutter and Atrial Tachycardia

Drug	Comment	Dose (IV)
Esmolol Metoprolol Verapamil Digoxin Amiodarone	Short-acting (half-life 8 min) beta-1 selective beta blocker May cause hypotension May cause hypotension Contraindicated in patients taking beta blockers or in heart failure Use if there is heart failure May be combined with digoxin for rate control in haemodynamically unstable patients	500μgm/kg over 1 min, followed by 200μgm/kg over 4 min 5 mg over 5 min, to maximum dose of 15 mg 5 mg over 5 min, to maximum dose of 15 mg 500–1000μgm in 50 mL saline over 1h Loading: 300 mg, diluted in 5% glucose to a volume of 20–50 mL, infused over 20 min via a central vein Maintenance: 900–1200 mg over 24h

Drug

Comment

Dose (IV)

Digoxin Amiodarone

Short-acting (half-life 8 min) beta-1 selective beta blocker

Contraindicated in patients taking beta blockers or in heart failure

Use if there is heart failure

May be combined with digoxin for rate control in haemodynamically unstable patients

500μgm/kg over 1 min, followed by 200μgm/kg over 4 min

5 mg over 5 min, to maximum dose of 15 mg

500–1000μgm in 50 mL saline over 1h

Loading: 300 mg, diluted in 5% glucose to a volume of 20–50 mL, infused over 20 min via a central vein

Maintenance: 900–1200 mg over 24h