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Poorly tolerated atrial ablation:
Significant hypotension
Pulmonary edema
Significant ischemia
DC cardioversion:
Minimum 200 J. synchronized shock
Acute Rate Control
IV calcium channel blockers
Diltiazem 20 - 25 mg bolus, then 10-15 mg/hour infusion
Verapamil 2.5 - 5 mg bolus
IV Digoxin
24 - 48 hours
Pharmacologic
Intravenous: procainamide/ibutilide
Oral loading
Electrical
External
Internal
Treat underlying cause if present
Rate control
Anticoagulating
Maintenance of sinus rhythm heart beat irregularity, palpitations in selected patients
Strong contraindication to warfarin: Aspirin 325 mg per day
Lone atrial fibrillation, less than 65: No treatment or aspirin