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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