Managing Atrial Fibrillation

7/18/2013 8:11:00 PM
I had a question I wanted to put out there about managing Afib.
I understand that if a patient is unstable on presentation with Afib they immediately go for synchronized cardioversion. However, if a patient is STABLE, what are the steps to management?

From what I am understanding so far, if it is known that the duration is less than 48 hours you proceed with cardioversion (I'm guessing that assuming that there would be no clot formation if its a new onset Afib). However if Afib is present for more than 48 hours, then you proceed with rate control with Beta blockers or Ca channel blockers. The next step is to start IV heparin, rule out other things like MI, TFT for Thyrotoxicosis, and TEE.

If TEE shows a clot, I know that anticoagulation with heparin and warfarin will proceed for 3-4 weeks, and the when the pt returns you can cardiovert them and continue anticoagulation for a further 4 weeks.

But what if the TEE does not show a clot? What do you do? Do you proceed with cardioversion or just keep the patient on betablockers and anticoagulation meds? (In MTB it says "long term use of rate control medications in combination with anticoagulation is equal or better than cardioversion)


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