AF acute RVR control

Q: Propranolol is a good choice to control ventricular rate in acute situations with atrial fibrillation (AF).

A) Yes

B) No

Answer: A

 

Intravenous (IV) metoprolol and esmolol are very popular amongst clinicians to control Rapid Ventricular Rate (RVR) in acute situations with AF. The objective of this question is to highlight the efficacy of propranolol in similar acute situations with AF. 

1 mg of IV propranolol over a minute is usually sufficient but, can be repeated up to three doses total. It has an advantage over metoprolol where clinicians may need to wait 5 minutes (sometimes quite a long time for a bedside clinician) between 2 doses. Propranolol can be repeated at 2 minutes intervals.

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References:

1. Kojuri J, Mahmoodi Y, Jannati M, Shafa M, Ghazinoor M, Sharifkazemi MB. Ability of amiodarone and propranolol alone or in combination to prevent post-coronary bypass atrial fibrillation. Cardiovasc Ther. 2009 Winter;27(4):253-8. doi: 10.1111/j.1755-5922.2009.00100.x. PMID: 19903189.

2. Reiffel JA. Drug choices in the treatment of atrial fibrillation. Am J Cardiol. 2000 May 25;85(10A):12D-19D. doi: 10.1016/s0002-9149(00)00902-4. PMID: 10822036.