- 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;
