Clinical Resources
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
Drug Dose Frequency Route Metoprolol 2.5mg-5mg every 5 minutes Maximum 10mg IV Sotalol 40mg-120mg Max 320mg/day PO Verapamil 2.5-5mg very slowly Repeat once only after 30 minutes IV Digoxin 0.75-1.5mg oral load as a single dose Mainentance 125mcg daily Oral Amiodarone 5mg/kg load over 30 minutes Then oral therapy to follow Magnesium Sulfate 20mmol Once IV 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 >100
- ECG shows iscahemia
- Significantly elevated or rising troponin
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
Drug Dose Frequency Route Metoprolol 2.5mg-5mg every 5 minutes Maximum 10mg IV Sotalol 40mg-120mg Max 320mg/day PO Verapamil 2.5-5mg very slowly Repeat once only after 30 minutes IV Digoxin 0.75-1.5mg oral load as a single dose Mainentance 125mcg daily Oral Amiodarone 5mg/kg load over 30 minutes Then oral therapy to follow Magnesium Sulfate 20mmol Once IV 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 >100
- ECG shows iscahemia
- Significantly elevated or rising troponin