How to decrease resting heart rate from tachycardia (abnormally fast heart rate)?

From the Guidelines

To decrease resting heart rate from tachycardia, the most effective approach is to use beta-blockers, such as metoprolol or esmolol, as they have been shown to be effective in controlling heart rate in patients with atrial fibrillation or tachycardia, as recommended by the 2011 ACCF/AHA/HRS guidelines 1. When managing tachycardia, it is essential to consider the underlying cause and the patient's overall health status.

• Lifestyle modifications, including regular aerobic exercise, stress reduction techniques, limiting caffeine and alcohol consumption, and ensuring adequate sleep, can help decrease resting heart rate.
• Medications, such as beta-blockers (metoprolol 5 mg IV over 1 to 2 minutes, repeated as required every 5 minutes to a maximum dose of 15 mg) and calcium channel blockers (diltiazem 15 to 20 mg IV over 2 minutes), can be used to control heart rate, as outlined in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
• In patients with atrial fibrillation, anticoagulants may be necessary to prevent stroke, and digoxin can be used to control heart rate at rest, especially in patients with heart failure or left ventricular dysfunction, as recommended by the 2011 ACCF/AHA/HRS guidelines 1.
• It is crucial to monitor heart rate regularly and seek immediate medical attention if symptoms such as chest pain, dizziness, or shortness of breath occur.
• Identifying and treating underlying causes, such as thyroid disorders, anemia, or sleep apnea, is also essential in managing tachycardia. The use of beta-blockers, such as metoprolol or esmolol, is supported by the highest quality evidence, including the 2011 ACCF/AHA/HRS guidelines, which recommend their use in controlling heart rate in patients with atrial fibrillation or tachycardia 1.

From the FDA Drug Label

Atenolol is a beta1-selective (cardioselective) beta-adrenergic receptor blocking agent without membrane stabilizing or intrinsic sympathomimetic (partial agonist) activities. In standard animal or human pharmacological tests, beta-adrenoreceptor blocking activity of atenolol has been demonstrated by: (1) reduction in resting and exercise heart rate and cardiac output, A significant beta-blocking effect of atenolol, as measured by reduction of exercise tachycardia, is apparent within one hour following oral administration of a single dose. Consistent with its negative chronotropic effect due to beta blockade of the SA node, atenolol increases sinus cycle length and sinus node recovery time.

Decreasing Resting Heart Rate from Tachycardia:

• Atenolol can be used to decrease resting heart rate from tachycardia due to its beta1-selective beta-adrenergic receptor blocking activity.
• The beta-blocking effect of atenolol is apparent within one hour following oral administration of a single dose and persists for at least 24 hours 2.
• Atenolol increases sinus cycle length and sinus node recovery time, which contributes to its negative chronotropic effect and reduction of resting heart rate.

Metoprolol is a beta 1-selective (cardioselective) adrenergic receptor blocker. Clinical pharmacology studies have demonstrated the beta-blocking activity of metoprolol, as shown by (1) reduction in heart rate and cardiac output at rest and upon exercise, Metoprolol slows the sinus rate and decreases AV nodal conduction

• Metoprolol can also be used to decrease resting heart rate from tachycardia due to its beta1-selective adrenergic receptor blocking activity.
• The beta-blocking effect of metoprolol reduces heart rate and cardiac output at rest and upon exercise, and slows the sinus rate 3.

From the Research

Decreasing Resting Heart Rate from Tachycardia

To decrease resting heart rate from tachycardia, several treatment options are available, including:

• Vagal maneuvers, which are the first line of treatment for stable narrow QRS complex supraventricular tachycardias (SVTs) 4, 5
• Adenosine, which is commonly used to treat SVTs, but may have negative short-term side effects 4, 5, 6
• Calcium channel blockers, such as verapamil and diltiazem, which may be as effective as adenosine in converting SVTs to sinus rhythm, without the negative side effects 4, 5, 7, 6
• Beta-blockers, which may be used to control heart rate, but are not recommended as a first-line treatment for AVNRT due to lower efficacy 5
• Digoxin, which may be used as an alternative treatment in difficult scenarios or resource-limited settings, due to its negative chronotropic effect and ability to suppress AV nodal conduction velocity 4

Pharmacological Treatments

Pharmacological treatments to control heart rate include:

• Beta-blockers, which can reduce heart rate and myocardial oxygen consumption 8
• Calcium channel blockers, such as verapamil and diltiazem, which can reduce heart rate and are commonly used to treat SVTs 8, 5, 7, 6
• Digoxin, which may be used to reduce heart rate in certain scenarios 4

Non-Pharmacological Treatments

Non-pharmacological treatments, such as vagal maneuvers, can be effective in converting SVTs to sinus rhythm and may be used as a first-line treatment 4, 5. Electrical cardioversion may be used for hemodynamically unstable patients 4, 5.