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Rate Control: Atrial Fibrillation with Rapid Ventricular Response - #MEDSHED

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💥 Atrial Fibrillation: Rate Control - #MEDSHED



💊 Metoprolol


MOA: Selective Beta-1 blocker


Dose 5 mg IV push every 5 minutes PRN x 3


Duration 4 hours | Half Life 4 hours


Metabolism Hepatic - CYP2D6


*Increased odds of achieving rate control when given with MgSO4 2 - 4 gm IV over 20 mins


Avoid in patients with decompensated HF



💊 Diltiazem


Dose: 0.25 mg/kg IV push. If rate control insufficient, repeat 0.35 mg/kg IV push. Transition to infusion at 5 - 15 mg/hr.


Mechanism Non-dihydropyridine CCB


Duration 1 hour | Half Life 4 hours


Metabolism Hepatic - CYP3A4


*Increased odds of achieving rate control when given with MgSO4 2 - 4 gm IV over 20 mins


Avoid in decompensated HF. Caution with hypotension.



💊 Digoxin


Dose: 250 - 500 mcg IV, then 250 mcg every 6 hours


Mechanism Inhibits NaKATPase pump, suppresses AV conduction


Duration 72 hours | Half Life 36 hours


Metabolism Urinary


*Consider in patients where BB or CCB are ineffective or contraindicated


Avoid in renal failure (reduced elimination, increased toxicities). Correct electrolyte abnormalities (hypokalemia, hypomagnesemia).



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Not medical advice. Educational purposes only. No relationships to report.



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