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