Cardioversion of Atrial Fibrillation
Successful cardioversion of atrial fibrillation
Posts
New Onset Atrial Fibrillation Part 4
Unstable Patient Control rate © Diltiazem: 0.25mg/kg over 2 minutes. If ineffective, in 15 minutes may repeat 0.35mg/kg over 2 minutes. Followed by a maintenance infusion of 5-15mg/hr* © Amiodarone (IIb) 150 mg given over 10 minutes and repeated if necessary, followed by a 1 mg/min infusion for 6 hours, followed by 0.5 mg/min. Total dose over 24 hours should not exceed 2.2 g.* Observe for bradycardia and hypotension. © Digoxin (class IIb) Digoxin 8 to 12 mcg/kg total loading dose, half of which is administered initially over 5 minutes, and remaining portion as 25% fractions at 4- to 8- hour intervals* Convert rhythm © Synchronized cardioversion © Pharmacologic cardioversion Synchronized cardioversion © Atrial flutter- 50J, and increase as needed © ...
New Onset Atrial Fibrillation Part 3
Symptomatic Patient Drugs and direct cardioversion Control rate © Calcium channel blockers (class I) © Beta blockers (class I) © Digoxin (class IIb) Note: Intravenous administration of beta blockers, digitalis, adenosine, lidocaine, and nondihydropyridine calcium channel antagonists, all of which slow conduction across the AV node, is contraindicated in patients with the WPW syndrome and tachycardia associated with ventricular preexcitation because they can facilitate antegrade conduction along the accessory pathway during AF resulting in acceleration of the ventricular rate, hypotension, or ventricular fibrillation. Calcium channel blockers (class I) © Diltiazem: 0.25mg/kg over 2 minutes. If ineffective, in 15 minutes may repeat 0.35mg/kg over 2 minutes. Followed by a maintenance infusion of 5-15mg/hr* © ...
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 © A...
New Onset Atrial Fibrillation Part 1
Atrial Fibrillation with rapid ventricular response Mnemonic for Treating New Onset Atrial Fibrillation P rimary Survey R eview history O btain 12 lead EKG V erify Date of Onset I ntervention goals D rugs and/or direct cardioversion E mboli Primary Survey © Airway- supplemental oxygen © Breathing © Circulation © Check VS © Assess pulse © Attach defibrillator/monitor © 12 lead EKG © IV access Note Because hypoxemia is a common cause of tachycardia, initial evaluation of any patient with tachycardia should focus on signs of increased work of breathing (tachypnea, intercostal retractions, suprasternal retractions, paradoxical abdominal breathing) and oxyhemoglobin saturation as determined by ...
ECG Rhythm Strip Quiz 85: Electrical interventions
Identify the rhythm and describe the electrical interventions associated with each rhythm. 1. a. Attempted defibrillation of ventricular fibrillation b. Attempted transcutaneous pacing of atrial flutter c. Attempted cardioversion of atrial fibrillation d. Attempted defibrillation of multifocal atrial tachycardia 2. a. Unsuccessful defibrillation of ventricular fibrillation b. Successufl cardioversion of atrial fibrillation c. External pacing of aystole with good electrical capture d. Failure to capture complete heart block 3. Is this the appropriate electrical intervention for this rhythm? a. Yes, synchronized cardioversion is an acceptable intervention for polymorphic VT b. Yes, overdrive pacing is being attempted for polymorphic ventricular tachycardia c. No, unsynchronized cardioversion is only appropriate this monomorphic VF d. No, ...
