Abstract Atrial fibrillation AF with rapid ventricular response is a common tachyarrhythmia requiring hospitalization. Patients receiving digoxin for ventricular rate control in atrial fibrillation or flutter will usually require more rapid loading than those treated with digoxin for heart failure, in whom a loading dose is typically not required.
If no thrombi are present, electrical cardioversion can be performed immediately; if thrombi are detected, cardioversion can be delayed until patients have undergone three weeks of oral anticoagulation using warfarin. Cardiac glycosides have important positive inotropic, neurohormonal, and electrophysiologic actions, which are the basis for its use in two clinical situations: Overall, AF is associated with cardioembolic events and heart failure, longer hospital stays, and reduced quality of life as well as a two- to fivefold increased mortality [ 21 — 232628 ].
See "Use of digoxin in heart failure with reduced ejection fraction".
The recommendations provided in this two-part article are consistent with guidelines published by the American Heart Association and the Agency for Healthcare Research and Quality.
Tier Description 1 This drug is available at the lowest co-pay. Digoxigenin bisdigitoxoside, digoxigenin monodigitoxoside active. Hypotension, bradycardia, QT prolongation, torsade des pointes, GI upset, phlebitis, constipation. Controlled studies in pregnant women show no evidence of fetal risk.
Dosing & Uses
Heparin should be administered to hospitalized patients undergoing medical or electrical cardioversion. Patients are usually monitored in the hospital while cardioversion is being attempted. If there is time and patients are conscious, sedation should be achieved before cardioversion is attempted. Inotropy and automaticity are subsequently increased while conduction velocity is reduced.
Earn up to 6 CME credits per issue. Analysis of current management of atrial fibrillation in the acute setting: Key areas of interest include: European Journal of Cardio-Thoracic Surgery.
Dronedarone is an oral multichannel blocker, which compared to amiodarone has a reduced lipophilicity and no iodine components. Although all calcium channel blockers can cause hypotension, verapamil should be used with particular caution because of the possibility of prolonged hypotension as a result of the drug's relatively long duration of action.
It is a highly lipophilic substance with a very large distribution volume and an extremely long half-life [ 4345 ].
Recent advances in treatment and the introduction of new drugs have not changed initial management goals in patients with atrial fibrillation.
Titrate lower loading doses of 2. These standard pharmacotherapies however, are contraindicated in ventricular preexcitation syndrome associated with rapid ventricular rate due to AF. Emerg Med Clin North Am.
Atrial fibrillation is the arrhythmia most commonly encountered in family practice.