By rray, 26 January, 2024 1st line tx for paroxysmal AF in younger pts w few comorbidities to reduce progression to persistent AF Consider in others First line for paroxysmal AF or persistent AF w o major risk factors for recurrence 1
By rray, 26 January, 2024 Useful if antiarrhythmic meds ineffective contraindicated not tolerated and in those w symptomatic clinically significant AFL ESC recommends ablation after 1 failed not tolerated BB tx 1
By rray, 26 January, 2024 Once converted consider catheter ablation in appropriate pts Ablation is more effective than antiarrhythmic drugs for persistent and paroxysmal AF
By rray, 26 January, 2024 Pill in the pocket strategy reasonable for select pts nbsp nbsp Test 1st as inpt trial w monitoring nbsp nbsp Give BB non DHP CCB PO 30min prior to single PO dose of flecainide or propafenone
By rray, 26 January, 2024 procainamide 1 g IV over 30min then 2 mg min over 1h Less effective than ibutilide AEs granulocytosis AV block HFrEF exacerbation hypotension neutropenia QT prolongation rash thrombocytopenia TdP Avoid if initially treated w amiodarone or ibutilide Consid
By rray, 26 January, 2024 amiodarone 5 7 mg kg or 300 mg then 1200 3000 mg IV over 24h Slow onset 8 12h AEs bradycardia hypotension QT prolongation phlebitis TdP May use if LVEF 40
By rray, 26 January, 2024 If hemodynamically stable or electric can t be performed use pharmacologic cardioversion Multiple medication options