Increases inotropy, relaxation, and chronotropy.β 1 (80% cardiac β receptors) receptor stimulation.Mixing BB and CCB, although sometimes necessary for rate control, may act synergistically potentiating AV nodal blockade, bradycardia, and hypotension. In regards to home medications, it may benefit patients to continue the same class of home medication. =>β- Blocker (BB) versus Nondihydropyridine Calcium Channel Blocker (CCB)īetween a BB and CCB, which is the best medication? The decision often encompasses multiple factors including contraindications, physician comfort, home medications, pharmacodynamics, etc. Therefore, for stable patients without pre-excitation, intravenous BB or CCB are recommended to slow rapid AF. It is prudent to purse rate control in the acute setting since it is contraindicated to cardiovert stable patients with AF >48 hours or unknown duration without anticoagulation. The RACE 1, 2 and AFFIRM 3 studies demonstrate rhythm-control has no survival benefit over rate-control.
High sympathetic tone states: sepsis, post-operative, hypovolemiaĪcute Management => Rate versus Rhythm Control Rheumatic heart disease (mitral stenosis)Īnemia (high output failure/tachycardia)/ Atrial Myxoma The PIRATES mnemonic is a helpful reminder although it is not complete. When a patient presents in new onset or rapid AF, a priority should be to identify and treat underlying disease or precipitating factors. CCB – Nondihydropyridine Calcium Channel Blocker.Nonvalvular – AF in absence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair.Permanent – Persistent for which cardioversion has failed or has not been attempted.Paroxysmal – Terminates spontaneously or with intervention within 7d.Author: Courtney Cassella, MD (EM Resident Physician, Icahn School of Medicine at Mount Sinai) // Edited by: Alex Koyfman, MD EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital) and Brit Long, MD AF – Atrial fibrillation
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