Pharmacologic agents for acute heart rate control in patients with multifocal atrial tachycardia and chronic obstructive pulmonary disease

MAT: multifocal atrial tachycardia; COPD: chronic obstructive pulmonary disease.
* For all patients with COPD and MAT and a rapid ventricular response, correction of hypoxemia, acidosis, and other metabolic disturbances is recommended. Theophylline can increase the ventricular response, so dosing should be regulated to keep the serum level in the range of 8 to 12 mg/mL; discontinuation of the medication should be considered.
¶ Verapamil is preferred over metoprolol for heart rate control of MAT in patients with COPD due to concerns about exacerbating bronchoconstriction.
Δ Representative of the type of selective beta-1 blockers that could be used, but similar drugs could be given in appropriate doses.
◊ Verapamil and beta blockers should not be given to patients with sinus node dysfunction or preexisting second- or third-degree block unless a temporary or permanent pacemaker has been implanted. Verapamil and beta blockers should be administered cautiously in patients with decompensated heart failure or hypotension to avoid worsening these conditions.