Click here to view next page of this article

Atrial fibrillation

Emergent/urgent Cardioversion

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

Elective Cardioversion

24 - 48 hours

Pharmacologic

Intravenous: procainamide/ibutilide

Oral loading

Electrical

External

Internal

Treatment of Atrial Fibrillation

Treat underlying cause if present

Rate control

Anticoagulating

Maintenance of sinus rhythm heart beat irregularity, palpitations in selected patients

Anticoagulation Recommendations

Strong contraindication to warfarin: Aspirin 325 mg per day

Lone atrial fibrillation, less than 65: No treatment or aspirin