Treatmentof acute atrial fibrillation rate and rhythm control

A. Patients who are unstable (ie, a heart rate of 150 or more with low blood pressure, angina pectoris, shortness of breath, decreased level of consciousness, shock, pulmonary congestion, congestive heart failure or acute myocardial infarction) during atrial fibrillation require immediate cardioversion using a 200-joule synchronized shock (with effective conscious sedation if time permits).

B. Restoration and maintenance of sinus rhythm often require the use of antiarrhythmic medications that carry a risk of proarrhythmia.

C. External direct current (DC) cardioversion is the most effective means of cardioverting atrial fibrillation to sinus rhythm. In patients with atrial fibrillation refractory to internal transvenous cardioversion, it is an alternative means of restoring sinus rhythm.

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