New Onset Atrial Fibrillation Part 2

Obtain 12 lead EKG

©      Obtain 12 lead EKG

©      Determine if QRS complex is ≥0.12 second

©      Determine treatment options.

Note:  Stable patients may await expert consultation because treatment has the potential for harm

Irregular Narrow Tachycardias

©      Atrial fibrillation

©      Atrial flutter

©      Sinus tachycardia with frequent premature beats

©      Multifocal atrial tachycardia (MAT)

Note:  Irregular narrow-complex tachycardias are likely atrial fibrillation or MAT; occasionally atrial flutter is irregular.  When there is doubt about the rhythm diagnosis and the patient is stable, a 12-lead ECG with expert consultation is recommended.

Irregular Wide Complex Tachycardias

©      Atrial fibrillation with aberrancy

©      Pre-excitation tachycardias (Wolff-Parkinson-White [WPW] syndrome)

Verify Onset Date

©      < 48 hours

©      > 48 hours

Note: Patients with an atrial fibrillation duration of >48 hours are at increased risk for cardioembolic events, although shorter durations of atrial fibrillation do not exclude the possibility of such events

Interventions Goals

©      Control rate

©      Convert rhythm

©      Prevent thromboembolism

Note:  Management of patients with AF involves 3 objectives—rate control, prevention of thromboembolism, and correction of the rhythm disturbance—and these are not mutually exclusive. The initial management decision involves primarily a rate control or rhythm control strategy. Under the rate control strategy, the ventricular rate is controlled with no commitment to restore or maintain sinus rhythm. The rhythm control strategy attempts restoration and/or maintenance of sinus rhythm.

Note:  Regardless of whether the rate control or rhythm control strategy is pursued, attention must also be directed to antithrombotic therapy for prevention of thromboembolism