Atrial fibrillation pharmacological cardioversion
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Atrial Fibrillation Microchapters | |
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Atrial fibrillation pharmacological cardioversion On the Web | |
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Directions to Hospitals Treating Atrial fibrillation pharmacological cardioversion | |
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Risk calculators and risk factors for Atrial fibrillation pharmacological cardioversion | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.
Overview
Chemical cardioversion refers to restoring the heart's rhythm to normal through pharmacological agents such as amiodarone, propafenone, and flecainide. Such medications work by altering the heart’s electrical properties to suppress the abnormal heart rhythms and restore a normal rhythm, and can be administered orally or intravenously. The treatment can be carried either in an in-patient or out-patient setting.
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[1]
Rhythm Control
Pharmacological Cardioversion: Recommendations
| Class I |
| "1. Flecainide, dofetilide, propafenone, and intravenous ibutilide are useful for pharmacological cardioversion of AF or atrial flutter provided contraindications to the selected drug are absent. (Level of Evidence: A) " |
| Class III: Harm |
| "1. Dofetilide therapy should not be initiated out of hospital owing to the risk of excessive QT prolongation that can cause torsades de pointes. (Level of Evidence: B) " |
| Class IIa |
| "1. Administration of oral amiodarone is a reasonable option for pharmacological cardioversion of AF. (Level of Evidence: A) " |
| "2. Propafenone or flecainide (“pill-in-the-pocket”) in addition to a beta blocker or nondihydropyridine calcium channel antagonist is reasonable to terminate AF outside the hospital once this treatment has been observed to be safe in a monitored setting for selected patients. (Level of Evidence: B) " |
Sources
- 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation [3]
- ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter [4]
References
- ↑ 1.0 1.1 January, Craig T.; Wann, L. Samuel; Alpert, Joseph S.; Calkins, Hugh; Cleveland, Joseph C.; Cigarroa, Joaquin E.; Conti, Jamie B.; Ellinor, Patrick T.; Ezekowitz, Michael D.; Field, Michael E.; Murray, Katherine T.; Sacco, Ralph L.; Stevenson, William G.; Tchou, Patrick J.; Tracy, Cynthia M.; Yancy, Clyde W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary". Journal of the American College of Cardiology. doi:10.1016/j.jacc.2014.03.021. ISSN 0735-1097.
- ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
- ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
- ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199