rate control for atrial fibrillation what is the best drug to use sinequan

Caution should be taken in patients on concomitant digoxin therapy. An important caveat to always keep in mind when considering acute ventricular rate control in a patient presenting with AF is to be certain that one is not dealing with the WPW (Wolff- Parkinson-White) syndrome and an accessory AV connection. Atrial fibrillation (AFib) is a type of arrhythmia, or abnormal heart rhythm.

When rates are not adequately controlled on a beta-blocker plus digoxin or calcium channel blocker plus digoxin, a third rate-control agent (a beta-blocker in those receiving a calcium channel blocker and vice versa) can be added. In treating AFib, your doctor will want to make sure your heart rate is under control. Alternative therapies with either rhythm control strategy or nonpharmacologic therapies to control the ventricular rate should be considered to prevent development of a tachycardiomyopathy. These drugs are negative inotropic agents and should be avoided in patients with heart failure or LV dysfunction. There are different types of blood thinners. Recommended dosing for esmolol is to bolus 500 mcg/kg over 1 minute, followed by 50 mcg/kg/min thereafter. Long-term rate control can be achieved by applying monotherapy or a combination therapy of beta-blockers, digoxin and non-dihydropyridine CCB. If patients have persistently rapid ventricular rates with symptoms despite the use of calcium channel blockers, beta-blockers, and digoxin at maximal doses, underlying disorders that shorten AV nodal refractory periods should be considered; for example, thyrotoxicosis, catecholamine excess, sepsis, or cardiomyopathy with elevated sympathetic tone and heart failure.

Rate control alone, however, is not necessarily better than rhythm therapy, and may not be an acceptable or suitable strategy for highly symptomatic patients despite rate control, in younger individuals, or in patients in whom exercise capacity is critical.

Although beta-blockers are preferred agents in patients with heart failure and LV systolic dysfunction, low doses of digoxin can be added to therapy with beta-blockers when target heart rate in not achieved with monotherapy, when increased beta-blocker dose is not well tolerated or when the added benefit of increased contractility is needed for heart failure symptom control. These criteria are similar to the target rates used in the AFFIRM and RACE trials of rate versus rhythm control. AV nodal ablation: The principle, nonpharmacologic approach to rate control in AF involves radiofrequency ablation (RFA) of the AV node and is sometimes considered if ventricular rate control cannot be achieved with AV nodal blocking drugs.
Digoxin: Given the availability of more effective acute rate control agents, digoxin usually is not considered first-line therapy for rapid, immediate management of AF, except perhaps in patients with heart failure or LV dysfunction. McComb, JM. These include medications as well as surgical or catheter procedures to help stop the arrhythmia. Additionally, these drugs can help prevent blood clots from forming. The clinician needs to adapt the therapeutic strategy to each individual patient.

Another concern is the potential long-term risk of developing left ventricular failure with chronic right ventricular pacing. Verapamil reduces renal clearance and hepatic metabolism of digoxin and increases serum levels of digoxin. Ganz, L. “Control of ventricular rate in atrial fibrillation: Pharmacologic therapy”.

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