• Atrial Fibrillation SSOU Admission Guideline

    Definition

    Atrial fibrillation (AF) in an otherwise well patient

    Admission Criteria

    • Age <70
    • Duration <24 hours/li>
    • Observation required while waiting for rate to fall below 100bpm

     

    Exclusion Criteria

    • HR >150 after initial treatment
    • Patient unable to complete Activities of Daily Living (ADLs) independently
    • Significantly elevated troponin

     

    Investigations

    Required

    • FBE, UEC
    • Glucose
    • Troponin
    • ECG
    • CXR

    As Required:

    • ECHO
    • Mg
    • TSH
    • Digoxin Level

     

    Suggested Medications

    In absence of heart failure Calcium Channel Blocker or Beta Blocker prefered, in CCF Digoxin or amiodarone preferedWhen ventricular response very rapid ensure K+normalised and consider MgSO4

    DrugDoseFrequencyRoute
    Metoprolol2.5mg-5mg every 5 minutesMaximum 10mgIV
    Sotalol40mg-120mgMax 320mg/dayPO
    Verapamil2.5-5mg very slowlyRepeat once only after 30 minutesIV
    Digoxin0.75-1.5mg oral load as a single doseMainentance 125mcg dailyOral
    Amiodarone5mg/kg load over 30 minutesThen oral therapy to follow 
    Magnesium Sulfate20mmolOnceIV

     

    Specific Observations

    None

     

    Specific Management Issues

    • Consider DCR (in ED, not in SSOU)

     

    Discharge Criteria

    • ECG - no ischaemia and rate <100
    • Cardiology and /or LMO follow up arranged
    • Suitable social situation

     

    Hospital Admission Criteria

    • HR persistenty &gt100
    • ECG shows iscahemia
    • Significantly elevated or rising troponin