Rx of Atrial fibrillation

- See: 
- A. Flutter 
- Causes of A. fib 
- r/o WPW as a predisposing cause; 
- If Unstable (or onset < 3 days): Cardio Convert (100 J) 
- If Stable: (w/ rates greater than 100/min) Consider 
- Digoxin: to slow the AV conduction rate 
- Propanolol
- Diltiazem 
- Verapamil 
- combination of Digoxin, Verapamil, and Beta blocker can lead to complete heart block, while Verapamil and propanolol can lead to sinus arrest; 
- After Slowing of AV conduction; 
- quinidine: may be used only after stabilization w/ Digoxin - Procainamide  
- either of these meds may convert A. fib to Normal Sinus Rhythm; 
- Class I agents should be withheld until adequate control of AV conduction has been obtained, as they enhance AV conduction; 
- New Onset Stable A. fib: 
- rate < 145, SBP > 100, & pt is awake, alert, and has no angina; 
- treatment is rapid Digitalization
- give 0.5 mg IV initially and 0.25 mg IV q6 hr for 2 or 3 additional doses for a total of 1 mg or 1.25 mg; 
- peak effect may not take effect for 90 to 120 min; 
- if patient does not slow after the initial Digoxin dose, additional drug may be given 0.25 mg IV q2hr until the heart rate slows

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, December 19, 2011 3:17 pm