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Management of Atrial Fibrillation

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Zafir Ahmed

on 15 February 2013

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Transcript of Management of Atrial Fibrillation

Atrial Fibrillation Is the patient Haemodynamically Unstable ? Yes Emergency DC Cardioversion NO Check
Time of Onset <48 Hrs > 48 Hrs No Flecanide Amiodarone
Age >65 yrs
Structural HD
Atrial Flutter Amiodarone YES NO Flecanide 2mg/kg, iv, 150 mg max
over 30 min
+ ECG Monitoring Contra Indications:
Atrial Flutter
Structural HD Amiodarone or 300 mg, IV
Over 30 min
via wide bore access administer Rate Control Indicated in case of:
Unclear time of onset
Mitral Valve Disease
Long Standing Paroxysmal AF Baseline Assessment Support in line with ABCs
Give Oxygen,
Monitor ECG, BP, SpO2
Secure IV access & take bloods
FBC, UE, TFT, Clotting, LFTs
Administer LMWH Features of Instability Reduced level of consciousness

Hypotension (SBP < 90 mmHg)

Chest Pain

Heart Failure

Acute Pulmonary Oedema

HR > 200 bpm unstable Patient Stable Patient "Paroxysmal AF" Seek Urgent Cardiology Support If patient remains ustable/AF presists:

Give Amiodarone
300 mg , IV
Over 20 - 30 min

Then re-attempt Cardioversion Persistent/ Permanent AF choice of Medication for rate control Beta blocker (bisoprolol 2.5 mg
Digoxin (500 mcg) Beta blocker (bisoprolol 2.5 mg)
Contraindication: Asthma
Causion: COPD, PVD, Bradycardia


Digoxin (500 mcg)
Caution: CKD choice of Medication for rate control Assess for presence of Calcium Antagonist (Diltiazem XL 180 mg)


Digoxin (500 mcg)Caution: CKD choice of Medication for rate control look for underlying Cardiac Failure/Sepsis, etc Administer Amiodarone, 300mg , IV
over 30 min, via wide bore access or Digoxin, if h/o heart failure or Indications of Admission to Hospital The Following patients should not be sent home:

Those with precipitating illness: Sepsis, HF, etc

All patients who had been compromised by AF

All patients who have received amiodarone

HR > 100 min should not be sent home AF tends to progress from
paroxysmal (self-terminating, usually 48 h) to
persistent [non-self-terminating or requiring cardioversion (CV)],
long-standing persistent (lasting > 1 year) & eventually to
permanent (accepted) .

First-onset AF may be the first of recurrent attacks
or already be deemed permanent.
Full transcript