Review Article

Management of Atrial Fibrillation in Critically Ill Patients

Table 2

Frequently used intravenous antiarrhythmic substances in the ICU.

SubstanceDosingHalf-lifeCommentary

Esmolol 1.0 mg/kg in boluses of 10–20 mg iv, followed by continuous infusion (start with 0.05 mg/kg/min, increase dose every 30 minutes if necessary)7–10 minGood efficacy in high adrenergic state. Positive effect on cardiovascular comorbidities. Consider negative inotropic effects

Diltiazem0.25 mg/kg iv over 2 minutes, followed by continuous infusion (10–15 mg/h) if necessary2–4 hLonger half-life as esmolol. No beta-blocking effects. Consider negative inotropic effects

Amiodarone
150–300 mg iv, followed by a continuous infusion (900–1200 mg daily) up to 0.1 g/kg
Maintenance dose 200 mg daily
20–100 dGood efficacy, safe in patients with structural heart disease. Extreme long half-life up to 80 days. Consider extracardiac side effects

Digoxin0.25–0.5 mg iv every 4–8 h up to 1 mg, followed by maintenance dose of 0.25 mg daily20 h–6 dPositive inotropic effect. Reduce dose in renal dysfunction. Check digoxin plasma levels to avoid toxicity