From the Guidelines
Amiodarone is a recommended treatment for atrial fibrillation with rapid ventricular response, with a typical loading dose of 150 mg IV over 10 minutes, followed by 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours, as supported by the most recent guidelines 1. The use of amiodarone for this condition is based on its ability to control the ventricular rate and convert patients to normal sinus rhythm, as shown in various studies 1. When considering treatment options, it is essential to weigh the potential benefits against the risks, including the potential for toxicity and drug interactions. Some key points to consider when using amiodarone for atrial fibrillation with rapid ventricular response include:
- Monitoring for hypotension during IV administration
- Baseline thyroid, liver, and pulmonary function tests to assess for potential toxicity
- ECG monitoring during initiation due to potential QT prolongation
- Regular monitoring of thyroid, liver, and pulmonary function every 6 months, as well as ophthalmologic exams annually, for long-term use
- Thorough medication review to assess for potential drug interactions due to CYP450 inhibition. Alternative rate control options, such as beta-blockers or calcium channel blockers, may be considered if amiodarone is contraindicated or not tolerated, as recommended by the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1.
From the Research
Treatment for Atrial Fibrillation with Rapid Ventricular Response
- Atrial fibrillation (AF) with rapid ventricular response (RVR) is a common tachyarrhythmia requiring hospitalization 2.
- The management of AF with RVR depends on the clinical presentation and the patient's hemodynamic stability 3, 2.
- Intravenous beta blockers and non-dihydropyridine calcium channel blockers are equally effective in rapidly controlling the ventricular rate in acute AF 3, 2.
- Amiodarone has a conversion rate in AF of up to 80% and is often used to convert AF to sinus rhythm (SR) 4.
- However, a study found that metoprolol had a lower failure rate than amiodarone in managing AF with RVR 5.
Pharmacologic Management
- The choice of pharmacologic agent depends on the patient's clinical situation, including the presence of underlying heart disease or other comorbidities 3, 6.
- Beta blockers are preferable in patients with myocardial ischemia, myocardial infarction, and hyperthyroidism, but should be avoided in patients with bronchial asthma and chronic obstructive pulmonary disease 3.
- Non-dihydropyridine calcium channel blockers are preferred in patients with bronchial asthma and chronic obstructive pulmonary disease 3.
- Amiodarone is effective in converting AF to SR, but its use is associated with a higher failure rate compared to metoprolol 5.