Atrial Fibrillation & Atrial Flutter

Treatment

• Unstable 
• Synchronized cardioversion
• 150-200J
  
• Stable
• Rate control with metoprolol
• 5-10mg IV
  
• May also use diltiazem, verapamil
• Avoid in WPW (use procainamide)
• Amiodarone
• in HFrEF (<40% EF)
• 5mg/kg over 30 minutes + 1200mg over 24 hours
• Cardioversion
• Only if onset < 48 hours ago
• Otherwise need 3 weeks anticoagulation
• TEE
• May attempt pharmacologically with ibutilide
  

 Notes

• Non-anticoagulated patients have 5% yearly embolic risk, 25% lifetime risk
• 10% yearly risk in DM2 or HF
  
• HR > 300 with wide QRS indicates pre-excitation syndrome like WPW