Atrial fibrillation with high ventricular rate in emergency room: What’s the best strategy for treatment?

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and can lead to significant decline in functional status and quality of life among affected patients. The risk of developing AF increases with age and the presence of structural heart disease. Thus, the attendance of patients with high ventricular response to AF is common, which makes knowledge of its management mandatory. In this context, the choice of heart rate and/or rhythm control therapy is fundamental and complex, with multiple possibilities. Thus, this review aims to assist in the management of these patients, systematizing their care.

How to Manage Atrial Fibrillation in the Emergency Department: a Critical Appraisal

“…Different combinations, such as propofol + ketamine, dexmedetomidine + propofol, or remifentanil instead of fentanyl can be used according to the team's experience and availability 16 . A dose of 10,000 units of unfractionated heparin should be administered as a bolus intravenously, based on anecdotal evidence 17 . The atrial stunning that occurs after an electrical cardioversion can last from 24 h to 1 month, depending on the duration of atrial fibrillation 18 .…”