Atrial Fibrillation
Suggested approach and Clinical Pearls
- Assess for shock state and extended therapy in critical care environment
- Determine need for electrical or chemical reversion and telemetry
- Consider additional causes for atrial fibrillation
- New or worsening cardiovascular status, new or worsening sepsis, electrolyte or endocrine abnormalities, inadequate usual medication
- Determine if atrial fibrillation is new or old
- New AF – aim for cardioversion in 1st 48 hours with echocardiography and anticoagulation – facilitated by general medicine and / or cardiology
- Old AF – aim for rate control primarily, with rhythm control as a secondary goal
- Determine location of care – ward, CCU or ICU
- ICU
- haemodynamically unstable AF
- AF needing amiodarone infusion in patient less than 3 days post-operatively with no surgical complications (Cardiology should not care for these patients in CCU)
- CCU
- Stable AF in patients without immediate post-operative issues who will receive amiodarone infusion
- Ward
- Stable AND
- Intermittent amiodarone OR
- Rhythm control only
- ICU