Tachycardia: Difference between revisions

The acute management of AF depends on the presentation of the patient. In stable patients with little complaints, rate control can be initiated with beta-blockers, non-dihydropyridine Ca-antagonists and digoxine. If the patient has recent onset of AF, is highly symptomatic or hemodynamicly compromised, cardioversion is indicated. Cardioversion can be performed medically or with electricity. The most effective drug  for chemical cardioversion is flecainide, although this drug is contra-indicated in patients with structural heart disease or ischemia.<cite>Martinez</cite> Another option is ibutilide, but this is mostly used and more effective to terminate AFL, and has a small risk of ventricular arrhythmias.<cite>Stambler</cite> In patients with severe structural heart disease amiodarone can be given.<cite>Chevalier</cite> Electrical cardioversion can achieved by a DC shock after sedation of the patient. If the AF persist for longer than >48 hours or the start of the episode is not clear, anti-coagulation should be initiated before (medical or electrical) cardioversion. Three weeks of adequate anti-coagulation (INR 2-3)is advised before cardioversion and it should be continued after cardioversion for 4 weeks to minimize thromboembolic risk.