Review Article
Management of Atrial Fibrillation in Critically Ill Patients
Table 2
Frequently used intravenous antiarrhythmic substances in the ICU.
| Substance | Dosing | Half-life | Commentary |
| 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 min | Good efficacy in high adrenergic state. Positive effect on cardiovascular comorbidities. Consider negative inotropic effects |
| Diltiazem | 0.25 mg/kg iv over 2 minutes, followed by continuous infusion (10–15 mg/h) if necessary | 2–4 h | Longer 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 d | Good efficacy, safe in patients with structural heart disease. Extreme long half-life up to 80 days. Consider extracardiac side effects |
| Digoxin | 0.25–0.5 mg iv every 4–8 h up to 1 mg, followed by maintenance dose of 0.25 mg daily | 20 h–6 d | Positive inotropic effect. Reduce dose in renal dysfunction. Check digoxin plasma levels to avoid toxicity |
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