ARRHYTHMIAS-AF RATE CONTROL

SUMMARY

1. The 2013 update to the ACC/AHA Practice Guideline states that a resting HR < 110 bpm is acceptable and stable LVEF > 40% Stricter control of 80-110 bpm (during 6-min walk) is required in HF or symptomatic patients.

2. Beta-blockers (atenolol, metoprolol) or CCB (verapamil, diltiazem) for rate control at rest & exercise. Digoxin can have a synergistic effect with these medications.

3. AF with HF: IV beta-blockers (esmolol, metoprolol, or propranolol) or amiodarone. Care with using CCB as these may exacerbate hypotension and HF due to negative inotopic effects.

5. Radiofrequency ablation of the AV node with permanent pacing is required for refractory AF.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].