Characteristics of Medication
Class Ia Procainamide
15-18 mg/kg IV over 30-60 minutes
~60 minutes TtC
  • Hypotension
  • Bradycardia
  • Ventricular proarrhythmia
Class Ic flecainide
300 mg po (> 70 kg)
200 mg po (≤ 70 kg)
2-6 hours TtC
  • Hypotension
  • Bradycardiaand conversion pauses
  • 1:1 conduction of atrial flutter*
Class Ic propafenone
600 mg po (> 70 kg)
450 mg po (≤ 70 kg)
2-6 hours TtC
  • Hypotension
  • Bradycardiaand conversion pauses
  • 1:1 conduction of atrial flutter*
Class III ibutilide
1 mg IV over 10 min May repeat x 1
30-60 minutes
  • QT prolongation
  • Torsades de pointes**
  • Hypotension
amiodarone
150 mg IV bolus then
60 mg/h x 6 hours then
30 mg/h x 18hours
8-12 hours TtC
  • Hypotension
  • Bradycardia
  • Atrioventricular block
  • Torsades de pointes
  • Phlebitis
vernakalant
3 mg/kg IV over 10 minutes, followed by 2 mg/kg IV if no conversion
12-30 minutes
  • Hypotension
  • Bradycardia
  • Non-sustained ventricular
  • tachycardia***

TtC: Time to Conversion

*Class Ic drugs (flecainide and propafenone) should be used in combination with AV nodal blocking agents (beta-blockers or calcium channel inhibitors). Class IC agents should be avoided in patients with ischemic heart disease or significant structural heart disease

**Consider pre-treating with 1-4 mg of IV MgSO4. Ibutilide should be avoided in patients with hypokalemia, baseline QT prolongation, or significant structural heart disease

***Vernakalant should be avoided in patients with hypotension, recent ACS, or significant structural heart disease