75
7.2.1. Acute Rate Control
COR LOE
Recommendations
1 B-R 1. In patients with AF with rapid ventricular response who are
hemodynamically stable, beta blockers or nondihydropyridine
calcium channel blockers (verapamil, diltiazem, provided that
EF >40%) are recommended for acute rate control (Figure 17).
2a B-R 2. In patients with AF with rapid ventricular response in
whom beta blockers and nondihydropyridine calcium
channel blockers are ineffective or contraindicated, digoxin
can be considered for acute rate control, either alone or in
combination with the aforementioned agents.
2a A 3. In patients with AF with rapid ventricular response, the
addition of intravenous magnesium to standard rate-control
measures is reasonable to achieve and maintain rate control.
2b B-NR 4. In patients with AF with rapid ventricular response who
are critically ill and/or in decompensated HF in whom beta
blockers and nondihydropyridine calcium channel blockers
are ineffective or contraindicated, intravenous amiodarone
may be considered for acute rate control.*
3: Harm B-NR 5. In patients with AF with rapid ventricular response and
known moderate or severe LV systolic dysfunction with or
without decompensated HF, intravenous nondihydropyridine
calcium channel blockers should not be administered.
* Consider the risk of cardioversion and stroke when using amiodarone as a rate-control agent.
