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Atrial fibrillation

Up Atrial fibrillation SVT Ventricular

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Types

Paroxysmal AF

  • terminates spontaneously
  • short term treatment goal: rate control

Persistent AF

  • does not terminate spontaneously
  • can be converted to sinus rhythm
  • short term treatment goals:
    • cardioversion to sinus rhythm
    • rate control

Permanent AF

  • does not terminate spontaneously
  • cannot be converted to sinus rhythm
  • short term treatment goal: rate control

Treatment

Rate control

Drug Speed of onset Effect Loading dose (IV) Maintenance dose(IV) Limitations
Amiodarone 30-60 mins ++ 300 mg   AF for >24-48 h unless patient anticoagulated for 3-4 weeks or atrial thombus excluded by TOE
Digoxin Hours (average 9.5) + (no more effective than placebo for paroxysmal AF) 0.25 mg every 2 h. Max 1.5 mg 0.125-0.25 mg daily Hyperadrenergic state
Diltiazem Minutes ++ 0.25-0.35 mg/kg over 2 min 5-15 mg/h Use with caution in congestive cardiac failure
Esmolol Minutes ++ 0.5 mg/kg over 1 min 0.05-0.2 mg/kg/min Negative inotrope

Further reading

Boriani G et al. Rate control in atrial fibrillation. Drugs, 2003;63(14):1489-1509

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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