Participants 396
| Drug | Mechanism of Action | Dose | Pharmaco-kinetics | Adverse Effects | Pearls |
| Metropolol | Acute beta blocker therapy for rate control strategy | Intravenous,
2.5 – 5 mg/kg in 2 minutes to a maximum of 3 doses |
Onset: 5 minutes | Hypotension, bronchospasm, bradycardia, AV block, heart failure | For patients with no significant HF, hypotension |
| Propranolol | Acute beta blocker therapy for rate control strategy | Intravenous, 0.15 mg/kg | Onset: 5 minutes | Hypotension, bronchospasm, bradycardia, AV block, heart failure | For patients with no significant HF or hypotension |
| Esmolol | Acute beta blocker therapy for rate control strategy | Intravenous, 500 mcg/kg over 1 minute
Maintenance Dose: 0.05 – 0.2 mg/kg/min |
Onset: 5 minutes
Duration of Action: |
Hypotension, bronchospasm, bradycardia, AV block, heart failure | Useful if uncertain that a beta blocker therapy will be tolerated |
| Verapamil | Calcium channel blocker for management of AF | Intravenous, 0.75 – 0.15 mg/kg in 2 minutes | Onset: 3 – 5 minutes | Hypotension, AV block, heart failure, bradycardia, interaction with digoxin | Pronounced negative inotropic effects
Not for hypotensive and heart failure patients |
| Diltiazem | Calcium channel blocker for management of AF | Intravenous, 0.25 mg/kg over 2 minutes
Maintenance Dose: 5 – 5 mg/h
|
Onset: 2- 7 minutes | Hypotension, AV block, heart failure, bradycardia | For absent pre-excitation
Lesser negative inotropic effects than IV verapamil
|
| Digoxin | Cardiac glycoside | Intravenous, 0.50 mg initially, then 0.25 mg q6h to max 1.5 mg
Maintenance Dose: 0.125 – 0.25 mg/day |
Onset: 2 hours | AV block, bradycardia, digitalix intoxication (GI, ocular, neurological, proarrhythmia) | For patients whose heart rate cannot be adequately controlled by BB or CCB
Not for older patients |
| Amiodarone | Heart rate control for patients with accessory |
Intravenous or Intraoral, 150mg over 10 minutes (repeat in 10 – 30 minutes if necessary)
Maintenance Dose: 0.5 – 1 mg/min IV, then 200mg daily, IO
|
Onset:
< 30 minutes |
Hypotension, pulmonary toxicity, hepatotoxicity, photosensitivity, corneal deposits, skin discoloration | Has long term side effects |
| Flecainide | For rhythm control strategy | Intravenous or Intraoral, 2 mg/kg IV over 10 minutes, or 200 – 300 IO
Maintenance Dose: 100 -150 mg q12h |
Onset: 2 – 4 hours | Decrease in BP, prolongs QRS duration, inadvertently increase ventricular rate | Not suitable for patients with marked structural heart disease, branch block or wide WRS complex, postinfarction scar, heart failure |
| Ibutilide | For rhythm control strategy | Intravenous, 1 mg IV over 10 minutes
Maintenance Dose: 1 mg IV over 10 minutes after waiting 10 minutes (if AF persists) |
Onset: < 90 minutes | Prolongs QT interval, torsades de pointes, slows ventricular rate, AV block | Causes LV hypertrophy, severe LV systolic dysfunction, ACS, and demands concurrent use of Class IA or III antiarrhythmics |
| Propafenone | For rhythm control strategy | Intravenous or Intraoral,
2 mg/kg IV over 10 minutes or 450 – 600 mg IO
Maintenance Dose: 150 – 300 mg or 8h IO
|
Onset: 3 – 4 hours | Decreases BP, prolongs QRS duration, slightly slows ventricular rate | Not for patients with marked structural heart disease
Contraindicated for coronoary heart disease |
| Vernakalant | For rhythm control strategy | Intravenous,3 mg/kg IV over 10 minutes Maintenance Dose: Second infusion of 2 mg/kg IV over 10 minutes after 15 minutes first infusion |
Sneezing, dysgeusia, paresthesia, nausea, cough, pruritus, dizziness, hyperhidrosis, hypotension | Contraindicated for moderate or severe HF and hypotension, caution in mild HF |