What is the first-line treatment for atrial fibrillation with rapid ventricular response in emergency medicine?

In emergency medicine, the first-line treatment for atrial fibrillation (AF) with rapid ventricular response typically focuses on achieving rate control to stabilize the patient. This is critical as rapid ventricular response is associated with increased heart rates that can lead to hemodynamic instability, symptoms such as palpitations, dyspnea, or chest pain, and potential complications such as heart failure or ischemia.

Utilizing beta-blockers or calcium channel blockers serves to reduce the ventricular rate by inhibiting conduction through the atrioventricular (AV) node. This helps improve patient comfort and cardiac function while minimizing the risk of serious complications associated with hemodynamic instability. Beta-blockers, such as metoprolol or propranolol, and calcium channel blockers, such as diltiazem or verapamil, are commonly used to effectively control the heart rate in these scenarios.

While anticoagulation with heparin is important in managing the risk of thromboembolic events in patients with AF, it does not directly address the urgent need to control the ventricular rate. Cardioversion can be effective in restoring normal sinus rhythm but is not the immediate priority when a rapid ventricular response is causing significant symptoms. Sodium bicarbonate infusion is not relevant in this