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+--- Thread: Atrial Arrythmias - ben (/showthread.php?tid=177647)
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Atrial Arrythmias - ben - ArchivalUser - 04-10-2007
If given the choices of Antiarrythmic Drugs to convert to sinus Rhthm, which would be the Doc below. UW say Ilbutilide but like to know if that's it correct or not
1. Procainamide
2. Amiodarone
3. Ilbutilide
4. Soltalol,
5. Quinidine
6.Propenafone
7. Dofetilide
Also any preferences of these drug in different situations. I know cd45 had posted a similar question
0 - ArchivalUser - 04-10-2007
Another Question
Once you have taken care of the Rate in a Pt w/ Aflutter or Afib will you still go on to convert them to sinus rhyth via Antiarrhtmis or will this depend on certain factors??
888888 - ArchivalUser - 04-10-2007
Management should focus on control of the rapid
ventricular rate (rate control) and conversion of hemodynamically
unstable atrial fibrillation to sinus rhythm (rhythm
control). Patients with atrial fibrillation for 48 hours are at
increased risk for cardioembolic events and must first undergo
anticoagulation before rhythm control. Electric or
pharmacologic cardioversion (conversion to normal sinus
rhythm) should not be attempted in these patients unless the
patient is unstable or the absence of a left atrial thrombus is
documented by transesophageal echocardiography.
Magnesium (LOE 3),34 diltiazem (LOE 2),35 and
-blockers (LOE 2)36,37 have been shown to be effective for
rate control in the treatment of atrial fibrillation with a rapid
ventricular response in both the prehospital (LOE 3)38 and
hospital settings.
Ibutilide and amiodarone (LOE 2)39“41 have been shown to
be effective for rhythm control in the treatment of atrial
fibrillation in the hospital setting.
In summary, we recommend expert consultation and initial
rate control with diltiazem, -blockers, or magnesium for
patients with atrial fibrillation and a rapid ventricular response.
Amiodarone, ibutilide, propafenone, flecainide,
digoxin, clonidine, or magnesium can be considered for
rhythm control in patients with atrial fibrillation of 48 hours
duration.
If a pre-excitation syndrome was identified before the
onset of atrial fibrillation (ie, a delta wave, characteristic of
WPW, was visible during normal sinus rhythm), expert
consultation is advised. Do not administer AV nodal blocking
agents such as adenosine, calcium channel blockers, digoxin,
and possibly -blockers to patients with pre-excitation atrial
fibrillation or atrial flutter (Box 14) because these drugs can
cause a paradoxical increase in the ventricular response to the
rapid atrial impulses of atrial fibrillation.
888888 - ArchivalUser - 04-10-2007
EXTRACTED FROM AHA-GUIDELINES 2005
0 - ArchivalUser - 04-10-2007
thank You
0 - ArchivalUser - 04-10-2007
just to be clear though
If the Pt is Stable w/ Afib of > 48 -- do a TEE to r/o Trombus before Elective Eectrical or Dug Conversion
If Pt is Unstable w/ AFib > 48 -- Urgent Electrical cardioversion regradless of Duration (no Anticoag Used here)
*So basically Anticoag used only if Afib is > 48 hrs,
otherwise, if < 48 hrs in Stable Pts (No Need for TEE) or in Unstable Pt No Need for Cradioversion before or After Cardioversion
0 - ArchivalUser - 04-10-2007
I meant
otherwise, if < 48 hrs in Stable Pts (No Need for TEE) or in Unstable Pt No Need for Anticoag before or After Cardioversion??
0 - ArchivalUser - 04-10-2007
Pls guys just need to confirm this once and for all
This Relates to Elective Sinus Ryhtm Conversion Only
1. Aflutter --do we need to Anticoagulate before and after Elective Drug or Electrical Cardioversion
2. Afib < 48 hrs
-- Do we need to Anticoag before and after procedure or not??
3. Afib > 48 hrs
--TEE 1st b/c of Increased Risk of Thrombus -- if Pos Anticaog then Cardioversion the Anticoah again??
0 - ArchivalUser - 04-10-2007
??
0 - ArchivalUser - 04-10-2007
BEN if the pt is dying .. unstable .. hyptensive ...we will obviously do cardioversion and we wont care how many hours /days into the afib he is
if less than 48 hors we dont antocoag
if more than 48 hours we antocoag or do a TEE to r/o clots... again pt shd be stable
less than 48 hours and stable
steps in order.. rate contriol then cardioversion then anticoag
more than 48 and stable
steps in order rate control then antocoag and then cardioversion after 6 weeks
if unstable more or less than 48 hours.. cardioversion first