Medical Conversion of Atrial Fibrillation with RVR: what do I do when beta-blockers and CCB’s fail?

6 Jul


Atrial Fibrillation with RVR

 *   IV Beta-blocker and Calcium Channel blockers are the first line IV drug choices

*   Various choices exist for the next line of therapy if these fail

*   A randomized prospective single-blind placebo-control trial was done comparing oral doses of Flecainide (3 mg/kg), amiodatrone (30 mg/kg), and propafenone (8.5 mg/kg) was performed with the primary end-point being 24 hour conversion to sinus rhythm

*   85% or greater was achieved with all medications (17% with placebo) within 48 hours

*   Conversion within 3 hours was greatest with propafenone (57.5%) compared to Flecainide (45%) and amiodarone (0%)
*   Amiodarone was more effective between 6 and 24 hours

BOTTOM LINE:

*   In the ED setting, Propafenone and Flecainide might be more useful than Amiodarone in non-emergent situations given the brief time that patients are treated in the Emergency Department

Submitted by W. Brooks:

Reference(s): Balla et al, Pharmalogical conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs, Anadolu Kardiyol Derg 2011 Nov;11(7):600-6; picture

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