October 2017

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Aaron I. -

For patients who are hemodynamically stable and come in with chronic/paroxysmal a fib with RVR who haven't had their normal beta blocker or CCB in the last 24 hours, how do you bridge them back to their oral therapy? Do you try giving them their normal PO med and watch them for the 30-60 minutes it takes for that to start working, or do you give them some IV meds to bring the rate down faster and then get them their PO meds once that starts being effective?

Jess Mason -

Hi Aaron. I think it all depends. It sounds reasonable to me to give them at least their home dose of their CCB or BB and then observe for a while. Patients who have paroxysmal AFib may continue to have episodes but we hope less frequently and shorter duration on their AV nodal blocking agent. IV meds are also certainly an option -- especially if it's something like metoprolol which is easy to give IV and then convert to PO.

chris r. -

Question about Diltiazem dosing in obese patients. I've seen a couple studies comparing fixed doses to weight based doses. I've read that Diltiazem dosing should be based on total body weight.

What is your approach to AFib with RVR in obese patients?

What would be your two IV bolus doses of Diltiazem in a normotensive patient (with sustained pulse 180's) that weighed 120kg? 200kg?

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