First-line medications for rate control in patients with new-onset AF include beta-blockers and calcium-channel blockers. Although these medications can be given orally, they are often administered intravenously to slow the ventricular rate of patients with new-onset AF. The ventricular rate in AF depends upon atrioventricular node conduction pathways (intrinsic) and underlying sympathetic and parasympathetic tone (extrinsic).
Amiodarone, a class III antiarrhythmic agent, may be considered as a last-resort treatment for rate control in patients who are unable to tolerate beta-blockers or calcium-channel blockers. However, if the duration of AF is longer than 48 hours, transesophageal echocardiography is recommended to exclude left atrial appendage thrombus before use of amiodarone.
Class V antiarrhythmic agents such as adenosine are not first-line medications for rate control in patients with new-onset AF. Adenosine is indicated as a treatment for paroxysmal supraventricular tachycardia. AF is a known adverse effect of intravenous adenosine.
Vitamin K antagonists such as warfarin are not first-line medications for rate control in patients with new-onset AF.
Catecholamines are not first-line medications for rate control in patients with new-onset AF. The adrenergic stimulation from catecholamines can cause AF. In addition to inducing AF, one study also showed that the catecholamine norepinephrine can increase the duration of an AF episode.
Learn more about the treatment of AF.
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Cite this: Sandeep K. Goyal. Fast Five Quiz: Clinical Management of Atrial Fibrillation - Medscape - Mar 13, 2023.