Atrial Fibrillation Rate Control Agents

Dilitiazem (Class IV)

0.25mg/kg IV over 2min, then infuse at 5-15mg/hr. If heart rate > 90 bpm after 15min, give second bolus of 0.35mg/kg

IV infusion 5-15mg/hr

PO 180-360mg/day

>> has negative inotropic effects, but has been safely in patients with heart failure

Amiodarone (Class III)

150mg IV over 10 min, and repeat if needed, then infuse at 1mg/min for 6hr, followed by 0.5mg/min for 18hr. Total dose should not exceed 2.2grams in 24hr.

IV infusion 1000mg/day

PO 200-400mg/day

>> can convert AF to sinus rhythm, which can be risky without adequate thromboprophylaxis. Preferred for AF with heart failure

Esmolol

500/kg IV bolus (60kg ; 3mg), then infuse at 50/kg/min

Metoprolol

2.5-5mg IV over 2min

Digoxin

ICU book 287