Treatment of AFib in the POAF setting typically involves heart rate reducing agents that allow the patient to convert to sinus rhythm.
Comparison of historical treatments
| Esmolol4 | Amiodarone5 | Digoxin6 | |
| Indication | Supraventricular tachycardia (atrial fibrillation or atrial flutter in perioperative, post-operative, or other emergent circumstances) or noncompensatory sinus tachycardia | Initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation (VF) and hemodynamically unstable ventricular tachycardia (VT) in patients refractory to other therapy | Control of resting ventricular response rate in patients with chronic atrial fibrillation; digoxin should not be used for the treatment of multi-focal atrial tachycardia |
| Administration | Continuous IV infusion – optional loading dose. Additional loading doses and/or titration of the maintenance infusion (stepwise dosing) may be necessary | IV loading infusion (10 min), slow dose X 6 hrs, maintenance infusion X 18 hrs. Preferred through a central venous catheter; use an inline filter during administration | Oral tablets, solution or capsules (preferred) or injection/IV. Complex dosing based on individual patient (lean BW, renal function, age, other meds, comorbidities) slowly over at least 5 min |