Narrow Irregular
Atrial Fib
Stable
Rate Control
with
Beta Blockers
Metoprolol
5 mg IV over 5 minutes
MR x 3 up to 15 mg total
Esmolol
10 to 30 mg IV
Drip 50 to 200 mcg/kg/min
Atenolol
5 mg IV over 5 minutes
May repeat in 10 minutes
Rate Control
with
Calcium Channel Blockers
Diltiazem
15 to 20 mg (0.25 mg/kg) over 2 minutes
Repeat 20 to 25 mg (0.35 mg/kg)
Drip 5 to 15 mg/hour (D5W or NS)
Verapamil
2.5 to 5 mg q 5 min
up to 20 mg
Rate Control
Reduced LV Function
Amiodarone
150 mg IV over 10 minutes
Digoxin
0.25 mg iv q 5 min
repeated up to 1 mg total
Giving Both
Calcium Channel and Beta Blockers
Can Cause
Complete Heart Block
Elective Cardioversion
Concerns about atrial thrombus and Cardioversion
Consider cardiologist and echocardiogram
Greater risk after 48 hours
