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Multifocal Atrial Tachycardia
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Atrial Fibrillation Chemical Cardioversion
- Time to Cardioversion: 3-6 hours
- Conversion Rate: 38-86%
- Chronic Efficacy: 47-60%
- Life Threatening Malaria
- Class Ia Antiarrhythmic (Sodium Channel Blocker, lengthens Action Potential duration)
- Similar activity as with Procainamide and Disopyramide
- Decreases the automaticity of ectopic foci
- Outside of nodes, increases heart refractory period including accessory pathways
- Decreases conduction velocity in the atria, HIs Bundle and Purkinje Fibers
- Paradoxically may increase AV Nodal conduction in rapid atrial rates due to Anticholinergic activity
- Results in QRS Widening and QTc Prolongation
- Consider initial hospital-based telemetry monitoring when starting Quinidine
- Primarily oral route (IV risks Hypotension, pain with IM Injection)
- Adult
- Quinidine Gluconate extended-release 324 to 648 mg orally every 8 to 12 hours
- Quinidine Sulfate immediate-release 200 to 400 mg orally every 6 to 8 hours
- Quinidine Sulfate extended-release 300 to 600 mg orally every 8 to 12 hours
- Child
- Quinidine Sulfate immediate-release
- Start (Test Dose): 2 mg/kg up to 200 mg
- Target: 15 to 60 mg orally every 6 hours
- Load Quinidine Gluconate 10 mg/kg (up to max 600 mg) IV over 1 to 2 hours
- Maintain Quinidine Gluconate 0.02 mg/kg/min for >= 24 hours
- Transition to oral Quinine or similar when Parasitemia <1%
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Protein Bound: 90%
- Hepatic metabolism with renal excretion
- Common
- Gastrointestinal (Nausea, Vomiting, Diarrhea)
- Serious
- Proarrhythmic
- Torsades de Pointes (Quinidine prolongs QTc)
- Ventricular increased response to Atrial Tachycardia
- Thrombotic Thrombocytopenic Purpura
- Mortality is increased when used in non-lethal Arrhythmia and comorbid CAD, CHF
- Cinchonism
- Neural, Retinal, and auditory toxicity related to Quinolones
- Quinidine increased metabolism with decreased effects
- Phenobarbital
- Phenytoin
- Quinidine potentiates other drugs
- Digoxin
- Vasodilators (increased risk of Hypotension)
- Warfarin
- Pregnancy Category C
- Considered safe in Lactation
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 74-5
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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