AFIB = Atrial FIBrillation. RVR = Rapid Ventricular Rate: ventricular rate >100 bpm. HU = Hemodynamically Unstable: hypotension (systolic BP <90 mm Hg) and evidence of shock (mental status changes or decreased urine output). HS = Hemodynamically Stable: normotensive, normal mentation, no evidence of shock. SDUR = Patient with AFIB <48 hours (Short DURation). If unknown or doubt as to genuine duration, assume LDUR. LDUR = Patient with AFIB >48 hours (Long DURation) or unknown duration. CDV = Direct current CarDioVersion. EL-CDV = ELective CDV: There is time to plan for procedure including informed consent, monitored anesthesia care, and assessing for intracardiac thrombus. If AFIB is LDUR, obtain a transesophageal echocardiogram prior to CDV. Abort CDV if any thrombus found and reassess after 3 weeks of anticoagulation. EM-CDV = EMergent CDV: Performed to save the life of the patient at the risk of thromboembolism. SAE = Search Alternate Etiology of shock: Being in AFIB with a normal ventricular rate does not cause shock. FAIL-CDV = Patient has had CDV in past and reverted back into AFIB. RC = Rate Control with goal of resting HR of 60–80 bpm, and <110 bpm with mild exertion. For RVR, consider metoprolol 5 mg IV Q15 minutes (max 15 mg) or diltiazem IV bolus 0.25 mg/kg IV followed by 10 mg/hr IV infusion (titrate over the range of 5–15 mg/hr IV for goal heart rate). For nonacute setting, consider metoprolol PO 25–100 mg twice daily or diltiazem 30–90 mg 3–4 times daily. |