By rray, 25 January, 2024 Avoid pharm conversion if sick sinus syndrome AV conduction disturbances QTc 500 ms 1
By rray, 25 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, 25 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, 25 January, 2024 If hemodynamically stable or DC can t be performed use pharmacologic cardioversion Multiple medication options
By rray, 25 January, 2024 If pt has obesity manual pressure augmentation or escalation of energy may improve success
By rray, 25 January, 2024 If initial shock unsuccessful or longer duration AF consider anterior post electrode vector orientation higher energy pre tx w antiarrhythmic drugs