ARRHYTHMIAS-AF ACUTE MANAGEMENT

SUMMARY

1. Rate (for minimal symptoms) vs. rhythm (for symptomatic patients) control. No difference in mortality/morbidity between the two.

DC CARDIOVERSION

2. DC cardioversion is the most effective method to restore sinus rhythm, recommended for haemodynamic instability, ongoing MI or HF.
3. Do not continue DC cardioversion if the patient repeatedly goes right back into A-fib shortly after being shocked.
4. Conraindicated in digitalis intoxication and hypokalemia.

PHARMACOLOGIC CARDIOVERSION
5. For AF < 7 days: flecainide, amiodarone.

ANTICOAGULATION
6. Patients with > 48 hrs (or duration unknown) of AF must be anticoagulated for 3 weeks prior to cardioversion.

7. After cradioversion anticoagulate with Warfarin (target INR 2-3) or NOAC.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].