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Walk the Even Hospital Database by book and chapter — the raw source passages that ground Ask, DDx, and the rest.
7 passages
Use only 1 of the following agents: Amiodarone (Class Ila) Ibutilide (Class Ila) Flecainide (Class Ila) Propafenone (Class Ila) Procainamide (Class Ila) Other drugs are Class IIb recommendations
NO DC cardioversion! Note: Conversion of AF to NSR with drugs or shock may cause embolization of atrial thrombi unless patient has adequate anticoagulation. Use antiarrhythmic agents with extreme caution if AF >48 hours duration.
THEN Anticoagulation x4 more weeks Impaired cardiac function (EF <40 percent or HF) (Does not apply) Note: If AF >48 hours duration, use agents to convert rhythm with extreme caution in patients not receiving adequate anticoagulation because of possible embolic complications.
Use only 1 of the following agents: Digoxin (Class lIb) Diltiazem (Class IIb) Amiodarone (Class Ilb) Anticoagulation DC cardioversion Note: may have proarrhythmic potential. The classes listed represent the AHA Class of Recommendation and not the Vaughn-Williams classification of antiarrhythmics. WPW: Wolff-Parkinson-White syndrome; AF: atrial fibrillation; NSR: normal sinus rhythm; TEE: transesophageal echocardlogram; EF: ejection fraction. Adapted from: Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 6: Circulation 2000 I-158.
Use only 1 of the following agents: Digoxin (Class lIb) Diltiazem (Class IIb) Amiodarone (Class Ilb) Anticoagulation DC cardioversion Note: may have proarrhythmic potential. The classes listed represent the AHA Class of Recommendation and not the Vaughn-Williams classification of antiarrhythmics. WPW: Wolff-Parkinson-White syndrome; AF: atrial fibrillation; NSR: normal sinus rhythm; TEE: transesophageal echocardlogram; EF: ejection fraction. Adapted from: Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 6: Circulation 2000 I-158. Guidelines for the control of rate and rhythm in atrial fibrillation/flutter-II Control rate Convert rhythm Cardiac function preservation Impaired cardiac function EF <40 percent of HF Duration <48 hours Duration >48 hours or unknown WPW Note: IF AF >48 hours duration, use agents to convert rhythm with extreme caution in patients not receiving adequate anticoagulation because of possible embolic complications. DC cardioversion
Class III (can be harmful) Adenosine Beta-blockers Calcium blockers Digoxin Note: If AF >48 hours duration, use agents to convert rhythm with extreme caution in patients not receiving adequate anticoagulation because of possible embolic complications. DC cardioversion
Class III (can be harmful) Adenosine Beta-blockers Calcium blockers Digoxin Anticoagulation followed by DC cardioversion Note: Occasionally 2 of the named antiarrhythmic agents may be used, but use of these agents in combination may have proarrhythmic potential. The classes listed represent the AHA Class of Recommendation and not the Vaughn-Williams classification of antiarrhythmics. WPW: Wolff-Parkinson-White syndrome; AF: atrial fibrillation; NSR: normal sinus rhythm; EF: ejection fraction; HF: heart failure. Adapted from: Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 6: Circulation 2000 I-158.