The following are excerpts on medications for rate control of atrial fibrillation from CAEP Acute Atrial Fibrillation/Flutter Best Practices Checklist [Link is to the PDF]:
The chart from the article should be reviewed first as it contains critical information on when rhythm control and rate control are not appropriate treatments for atrial fibrillation.
Calcium channel- and beta- blockers considered first line
- If patient already taking oral calcium-channel or beta- blocker, choose same drug group first
- If difficulty achieving adequate rate control, consider using the other first-line agent, IV digoxin, or cardiology consultation
- Calcium channel blocker: avoid if acute heart failure or known LV dysfunction
- Diltiazem 0.25 mg/kg IV over 10 minutes; repeat q15-20 min at 0.35 mg/kg up to 3 doses
- Start 30-60 mg PO within 30 mins of effective IV rate control
- Discharge on 30-60mg QID or Extended Release 120-240 mg once daily
- Beta Blocker – Metoprolol 2.5-5 mg IV over 2 minutes, repeat q15-20 min up to 3 doses
- Start 25-50 mg PO within 30 mins of effective IV rate control
- Discharge on 25-50 mg BID
- Heart rate target achieved: <100 bpm at rest, <110 walking
