Atrial Fibrillation

Most common chronic rhythm

Paroxysmal AF - episodes of AF generally last less than seven days (usually less than 24H) and may be recurrent.

Persistent AF - fails to self-terminate and lasts for longer than seven days.  Persistent AF may also be paroxysmal if it recurs after reversion.  AF is considered recurrent when the patient experiences two or more episodes.

Permanent AF - is considered to be present if the arrhythmia lasts for more than one year and cardioversion either has not been attempted or has failed.

Lone AF - describes paroxysmal, persistent, or permanent AF in individuals without structural heart disease.


Basics: on admit - ECG, CXR, TSH, CBC

Consider: ECHO (eval EF, valves, LA, effusion); serial cardiac enzymes

Immediate needs:
Rate control goals:
Rest HR < 80
Average HR < 100
No HR > 110% of age-predicted Max

Medical Management
Rate control via beta blockade, Diltiazem or Verapamil
Heparin Anticoagulation
Consider Rhythm Control
Keep NPO after MN for possible studies, ie. TEE/DCCV

Documented AF < 48H probably don't need TEE ASK FIRST
Will need warfarin INR 2-3 for 4 weeks post Cardioversion
If AF duration > 48H/ unknown duration:
    4 weeks of warfarin, INR 2-3, prefer INR 2.5
    Elective DCCV
    Continue warfarin, INR 2-3 for 4 weeks post DCCV