| Management of atrial fibrillation in the emergency department and following acute myocardial infarction. | |
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MedLine Citation:
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PMID: 16239990 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Atrial fibrillation (AF) is the most common arrhythmia managed by emergency physicians and there is increasing evidence that selected patients with acute AF can be safely managed in the emergency department without the need for hospital admission. The principles of management are identification and treatment of precipitating or underlying causes, hemodynamic stabilization/rate control, reduction of thromboembolism risk and the conversion/maintenance of sinus rhythm. A strategy of rate or rhythm control should be chosen based on the patient's clinical status, the duration of AF, the experience of the treating physician and the status of anticoagulation. Before either electric or pharmacological cardioversion, anticoagulation should be considered. Most patients should be given heparin or low molecular weight heparin while preparing for cardioversion. All patients should be considered for long-term anticoagulation based on their thromboembolic risk and bleeding risk from antithrombotic therapy. Following restoration of sinus rhythm, a decision regarding the use of antiarrhyhmic drugs should be made based on the estimated frequency of recurrence and degree of symptoms. In the setting of acute myocardial infarction, beta-blockers should be administered whenever possible. If beta-blockers are contraindicated, the rate can be slowed with digoxin or amiodarone. Cardioversion should be performed if the patient is hemodynamically unstable. Class IC antiarrhythmic drugs should not be administered in this setting. |
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Authors:
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Brett Heilbron; George J Klein; Mario Talajic; Peter G Guerra |
Publication Detail:
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Type: Consensus Development Conference; Journal Article |
Journal Detail:
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Title: The Canadian journal of cardiology Volume: 21 Suppl B ISSN: 1916-7075 ISO Abbreviation: Can J Cardiol Publication Date: 2005 Sep |
Date Detail:
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Created Date: 2005-10-21 Completed Date: 2007-10-10 Revised Date: 2008-04-09 |
Medline Journal Info:
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Nlm Unique ID: 8510280 Medline TA: Can J Cardiol Country: Canada |
Other Details:
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Languages: eng Pagination: 61B-66B Citation Subset: IM |
Affiliation:
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University of British Columbia, Vancouver. bheilbron@telus.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Atrial Fibrillation
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etiology*,
therapy* Emergency Service, Hospital Emergency Treatment* Humans Myocardial Infarction / complications* Practice Guidelines as Topic |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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