Table 3. Rate Control Therapies for Atrial Fibrillation in the Emergency Department
Agent | IV Administration | Oral Maintenance Dose
| Contraindications
|
Beta Blockers | |||
Metoprolol tartrate | 2.5-5 mg IV bolus every 5 min up to 15 mg | 12.5-200 mg BID | Contraindicated in acute asthma and acute heart failure |
Metoprolol succinate (XL) | N/A | 50-400 mg daily | Contraindicated in acute asthma and acute heart failure |
Esmolol | 500 mcg/kg IV bolus over 1 min; followed by 50-300 mcg/kg/min | N/A | Contraindicated in acute asthma and acute heart failure |
Carvedilol | N/A | 3.125-25 mg BID | Contraindicated in acute asthma and acute heart failure |
Non-dihydropyridine Calcium-Channel Blockers
| |||
Diltiazem | 0.25 mg/kg IV bolus over 5 min (max 20 mg), then 5-15 mg/hr; may give 0.35 mg/ kg (max 25 mg)15 min after first bolus if not adequate response | Immediate release: 30-120 mg QID
Extended release: 120-480 mg daily | Contraindicated in heart failure with reduced ejection fraction |
Verapamil | 5-10 mg IV bolus over 5 min | Immediate release: 40-160 mg TID
Extended release: 120-480 mg daily | Contraindicated in heart failure with reduced ejection fraction |
Other
| |||
Digoxin | 0.25 mg IV q6h to a max of 1.5 mg in 24 hr | 0.125-0.25 mg daily | Contraindicated in acute and chronic kidney disease |
Amiodarone | 150 mg IV over 10 min, followed by 1 mg/ min IV for 6 hr, then 0.5 mg/min IV for 18 hr | 100-200 mg daily after loading period | Contraindicated in thyroid disease |
