The different rate control agents act on the atrioventricular (AV) node to prolong its refractory period and to slow its conduction. Pharmacologic Options Rate control consists of controlling the ventricular rate to slow down its response. By doing so, one avoid the hemodynamic instability associated with tachycardia such as heart failure, and angina, and prevent long term tachycardia-mediated cardiomyopathy. Unfortunately, one may also have to face unwanted side effects, such as hypotension and bradycardia, for the same reason. In most situations, medication can be administered through the per os (PO or oral) or intravenous (IV) route. As expected the intravenous form provides a faster onset of action. The four main classes of rate control agents consist of; beta-blockers (metoprolol, atenolol, propanolol), calcium channel blockers (diltiazem, verapamil), sodium-potasium ATPase inhibitors (digoxin), and class III antiarrhythmic agents such as amiodarone. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Atrial flutter is less common than atrial fibrillation but its management in the ED is very similar, and the majority of patients with atrial flutter also have atrial fibrillation. Listing a study does not mean it has been evaluated by the U. Symptomatic relief and ventricular rate control are generally the primary therapeutic objectives in the ED management of acute atrial fibrillation and flutter (AFF). Acute atrial fibrillation is the most common sustained, clinically significant dysrhythmia encountered in the emergency department (ED) and the most common dysrhythmia treated by emergency physicians. The need for swift, appropriate action by the emergency physician is highlighted by the fact that up to 18% of patients with AFF develop potentially life-threatening complications such as congestive heart failure, hypotension, ventricular ectopy, respiratory failure, angina and myocardial infarction. Both beta-blocking agents and calcium channel blockers are commonly used to treat AFF in the ED. Metoprolol is the most commonly used beta-blocker; and diltiazem is the most frequently used calcium channel antagonist. Diltiazem was released by the FDA for treatment of AFF in 1992. were the first to demonstrate both the efficacy of diltiazem in the ED management of AFF with rapid rate and its clear superiority over the previously most commonly used pharmacologic agent, digoxin. To date, only one prospective, randomized trial has compared the effectiveness of a calcium channel blocker (diltiazem) with a beta-blocker (metoprolol) for rate control of AFF in the ED.
Hello – I’m an otherwise healthy 55 year old female, diagnosed with afib 1.5 years ago. that diagnosed it immediately prescribed warfarin and metoprolol. was away at the time, and when she returned 3 months later, she said “I probably would have only put you on aspirin” – because I am otherwise healthy. No other risk of stroke, my bp is fine, blood sugar is fine, no history of heart attack, etc. But she decided to run the tests and try to determine my afib trigger, so I have since had an echo to check my heart’s mechanical health (its good), sleep apnea test (I have mild, and am now on a device that treats it), and I’ve quite drinking alcohol. please read the following link: Arrhythmia/Treatment-Guidelines-of-Atrial-Fibrillation-AFib-or-AF_UCM_423779_the need for anticoagulation depends of your CHA2DS2–VASc risk.. I saw an internist that decided I had alcohol induced afib. after reading you will be entirely informed ,and you are able to discuss your treatment better with the doctors. However, I suspect that my afib may also be triggered by hormone fluctuations caused by the peri-menopause I’m going through, but every dr. to review my sleep apnea results, and maybe since it’s under control, I will be able to get off the warfarin. Has anyone every been on warfarin and a beta blocker, and then been able to get off both of them? Special thanks @yoanne for the reference to the Heart Association’s guidelines on A-fib diagnosis and treatment and the Internet link to bring them up to read. I’ve suggested it to says probably not, hard to prove. On that page is another link that takes us to an online tool for calculating your risk of a stroke from A-fib and the need for anticoagulation therapy. As @yoanne advises, print those two pages and take them with you to discuss them with your cardiologist(s). Ever since I was put on the 2 meds, I have been asking to get off them. wanted me to go through all the tests, and then decide. only works half time, so I am constantly seeing a new dr. I had basically said I have no choice but to stay on the drugs. The tool recommends that I take a “blood thinner,” although my risk of a stroke is based only on my age (over 65) and my hypertension. Metoprolol is prescribed for High Blood Pressure, Tachycardia, Palpitations, PVC's, Arrythmia, Chest Pain and Heart Attack and is mostly mentioned together with these indications. In addition, our data suggest that it is taken for A Fib and Anxiety, although it is not approved for these conditions*. Read More Overdosed at diagnosis of afib--100 mg and had uti symptoms. Four months of overdose later--Cancer of kidney and bladde,r and will have both removed tomorrow, Urologic surgeon says bladder cancer can indeed happen in four months' time. Scared at first to take it but I was told take it works for you it will save your life after going to the ER enough times. It's took some adjustments but it was worth taking !!!?? Making healthy life style changes helps as well now that I'm on the meds!!! AMADORONE is a medication that should not be taken for a long period of time. It causes skin discoloration and you cannot go out into the sun while taking it.
Comparison of Diltiazem and Metoprolol in the Management of Acute Atrial. to a maximum dose of 30 mg or metoprolol administered at a dose. Metoprolol for treating A Fib. Our data suggest that Metoprolol is taken for A Fib. " How to dose metoprolol for chronic Afib in patients.