Case Reports in Emergency Medicine / 2015 / Article / Tab 1

Case Report

The Unexpected Pitter Patter: New-Onset Atrial Fibrillation in Pregnancy

Table 1

DrugRate versus rhythm controlClass of recommendation/level of evidenceFDA categoryDosageAdverse effects

Beta-blockersRateClass IIa/CC Pregnancy: born small for gestational age, preterm birth, and perinatal mortality [1]. General: bradycardia, hypotension, AV block, bronchospasm
EsmololLoading: 0.5 mg/kg over 1 min. Maintenance: 0.06–0.2 mg/k/min
Metoprolol2.5–5 mg bolus over 2 min, up to 3 doses
Propranolol0.15 mg/kg
Nondihydropyridine calcium channel blockersRateClass IIa/CC Pregnancy: increased risk of neonatal seizures, jaundice, and hematologic disorders [2]. General: hypotension, heart failure
DiltiazemLoading: 0.25 mg/kg/dose over 2 min; may give a second dose at 0.35 mg/kg/dose. Maintenance: 5–15 mg/kg for <24 hr.
Verapamil0.075–0.15 mg/kg over 2 min

Cardiac glycoside
DigoxinRateClass IIb/CCLoading: 0.25 mg IV every 2 h, up to 1.5 mg.
Maintenance 0.125–0.375 mg daily IV or orally
Pregnancy: digitalis toxicity may cause fetal demise [3]. General: digitalis toxicity, heart block

Class I C antiarrhythmic agent
FlecainideRhythmClass IIb/CCGeneral: heart block, ventricular arrhythmias, and heart failure

Class III antiarrhythmic agent
IbutilideRhythmClass IIb/CC1 mg IV; may repeat dose if no response after 10 minGeneral: bradycardia, AV block, Torsades

Adjunctive therapies
MagnesiumNAB2 g over 15 minGeneral: respiratory depression

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