Originally Posted by Planktonmd
Agree with Noyac on this one: Verapamil depresses the AV conduction more than Diltiazem and this is exactly why I like it for Afib with RVR.
Is verapamil your goto drug then?
I thought one of the things that changed with the new ACLS guidelines was removal of verapamil as a first line agent for afib rate control. Am I wrong here?
I think the only place the 2005 ACLS guidelines include verapamil in the algorithm are (IIRC) as an alternative to diltiazem in stable patients with SVT and preserved LV function (stable bad hearts get digoxin or amiodarone; unstable patients get shocked, then either dilt or amio).
For rate control in afib or flutter ... after digging out my 2005 cards I don't see verapamil on the afib chart. Unstable patients get shocked but stable patients with rate >150 get digoxin if their heart sucks, amiodarone for WPW, otherwise a beta blocker or diltiazem.
I sort of vaguely remember someone telling me that the reason verapamil was de-emphasized for afib RVR was the risk it carries when given to someone who really has WPW, and that it's easy to mistake WPW for garden variety afib RVR when the rate's high and all you've got is a rhythm strip. This made little sense to me because if the patient's dying you're going to shock him, and if he's not dying there's no reason not to get a 12-lead before giving any drugs.