![]() See the article titled: Management of new onset atrial fibrillation. Even though that’s so, all patients who undergo cardioversion (even those who have no thrombus seen on TEE) should be on therapeutic anticoagulant therapy at the time of TEE/cardioversion as well as for one month after the cardioversion.” The TEE strategy doesn’t require at least three weeks of anticoagulation. ![]() Alternatively, you may do a TEE screening for the presence of atrial thrombi before cardioversion. “For pts with AF of longer than 48hrs duration, do at least three consecutive weeks of effective oral anticoagulation before cardioversion, as opposed to immediate cardioversion.Some start unfractionated heparin, low molecular weight heparin, or a DOAC prior to cardioversion in all patients, while some go ahead without anticoagulation in patients with AF of very short duration who have a low stroke risk profile. ![]() In pts with AF less than 48 hrs duration, cardiologists differ in how they approach anticoagulation.Calculate a CHA2DS2-VASc score for every patient.IV drugs are preferred to oral drugs when rapid rate control is necessary.” “The decision between IV or PO treatment depends on the clinical presentation and the need and urgency for controlling the rate.Beta blockers and non-dihydropyridine calcium channel blockers are preferred as first-line agents in most patients.For asymptomatic pts with permanent AF, a rate control goal of <110 beats/min is reasonable. Documentation for IV drip needs to include. Time, dosage, and route of IVP medication given. A goal heart rate on rate control of less than 85 bpm is reasonable in symptomatic patients. Lidocaine documentation: EKG rhythm at time of need of medication.See this diltiazem protocol from the ACC. The goal HR should be <85 (and SBP greater than 100) if the patient is symptomatic at higher HR. Under Order Comments section, add the following instructions: Start at 5 mg/hrįor a goal HR less than 110 (and SBP greater than 100) if the patient is asymptomatic at HR < 110. In PowerChart, search and from the drop-down, choose: Diltiazem 125mg in 125ml D5W
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