Atrial fibrillation or AF is the most common cardiac arrhythmia in general population. AF is a supraventricular tachyarryhythmia characterized by uncoordinated atrial electrical conduction, which resulted in a deterioration of mechanical function.
Signs and symptoms are chest pain, palpitations, dyspnea, fatigue and syncope. Diagnosis of AF requires ECG which will display rapid oscillations of varying amplitude, shape and timing that replace consistent P waves.
Management
The treatment goals for AF are the restoration and maintenance of sinus rhythm and the prevention of thromboembolic complications.
Elective cardioversion
Pharmacologic cardioversion
Amiodarone
[po/iv]
for po route
Inpatient: 1.2-1.8 gm/day in divided doses until 10gm total then 200-400 mg per day.
Outpatient: 600-800 mg per day until 10gm then 200-400 mg per day
for iv route
5-7mg/kg over 30-60min then 1.2-1.8 gm/day cont iv or divided po doses until 10gm total then 200-400 mg per day
Dofetilide
for po route
500 mcg bid - must adjust if CrCl < 60 ml/min
Flecainide
[po/iv]
for po route 200-300 mg
for iv route 1.5-3 mg/kg over 10-20 min [available only in Europe]
Ibutilide
for iv route only
pt over 60 kg: 1mg over 10 min - may repeat 1mg when necessary
pt less than 60 kg: 0.01 mg/kg over 10 min and may repeat the same dose only once after 10 min if necessary
Propafenone
[po/iv]
for po route 600 mg
for iv route 1.5-2 mg/kg over 10-20 min [available only in Europe]
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