Dilemmas in the acute pharmacologic treatment of uncontrolled atrial fibrillation.
A recently conducted observational study of the prehospital treatment of uncontrolled atrial fibrillation brought to light therapeutic inconsistencies by emergency providers in dealing with this dysrhythmia. A review of the literature suggests that digoxin lacks efficacy in controlling ventricular rate in atrial fibrillation and that the slow onset of digoxin makes its use in the emergency setting questionable. Because of their demonstrated ability to rapidly slow ventricular rate, the calcium channel blocker, diltiazem, or the beta-adrenergic blocker, esmolol, should be the preferred agents for treating rapid atrial fibrillation in the emergency department or the paramedic ambulance.
Elam
K
K
Emergency Department, St. Joseph Medical Center, Tacoma, WA 98415, USA.
Bolar-Softich
K L
KL
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004077:Digoxin / Q000627:therapeutic use; D004110:Diltiazem / Q000627:therapeutic use; D004632:Emergency Medical Services; D006801:Humans; D011412:Propanolamines / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D011412:Propanolamines; D004077:Digoxin; D004110:Diltiazem; C036604:esmolol