TREATMENT OF ATRIAL FIBRILLATION

• Address the cause - not just the rate and rhythm!
• Do not slow heart rate if circulatory volume is marginal (e.g. hypovolaemia, sepsis) - you may cause the patient to arrest!
• Circulatory support with invasive haemodynamic monitoring may be required prior to rate control
• AF duration > 48 hrs old oshould be considered candidates for anti-coagulation +/- cardioversion

CAUSES

• Hypovolaemia
• Sepsis/Infection
• Hypoxia
• Ischaemia/Infarction
• Electrolyte abnormalities
• Drug toxicity

DRUG ALGORITHM FOR ATRIAL FIBRILLATION

(see descriptions of drugs at bottom of page)

• Amiodarone - preferred agent for reversion in patients with heart failure/structural heart disease
• Sotalol - beta-blockade effects may be beneficial in acute ischaemia
• Flecainide - use with caution in patients with structural heart disease
• Digoxin - mildly positive inotropic (all other agents are negatively inotropic to varying extents), slow in onset, does not achieve cardioversion
• Beta-blockers - contraindicated in concurrent calcium channel use, asthma, hypotension and heart failure.  Rapid rate control can be achieved
• Calcium-channel blockers - contraindicated in concurrent beta blocker use, hypotension and heart failure.  Rapid rate control can be achieved
• Magnesium sulphate - can cause hypotension.  Useful even in normomagnesaemia.