Supraventricular tachyarrhythmias and rate-related hypotension: Cardiovascular effects and efficacy of intravenous verapamil

Treatment of tachyarrhythmias

“…In patients with atrial fibrillation or flutter, preserved LV function, and a heart rate 120 beats/min or greater, evidence published before and since 1992 supports initial efforts at obtaining rate control with diltiazem (6 studies of fair-to-excellent quality, LOE 2, [162][163][164][165][166][167] and 2 studies of fair-to-good quality, LOE 5 168,169 ), β-blockers (6 studies of fair quality, LOE 5, [170][171][172][173][174][175] and 1 study of good quality, LOE 2 176 ), verapamil (6 studies of good-to-excellent quality, LOE 2, 164,177-181 and 3 studies of fair-to-good quality, LOE 5 [182][183][184] ), or digoxin (1 study of good quality, LOE 2 185 ). Available evidence (from both placebocontrolled and comparative studies of β and calcium channel blockers) suggests that digoxin is the least potent agent and has the slowest onset of action of the available pharmacologic options for ventricular rate control.…”