Just the facts: atrial fibrillation or flutter in patients who are candidates for rhythm control

Abstract

Clinical scenarioA 64-year-old man presents to the emergency department (ED) with palpitations that started at rest six hours ago. He denies chest pain or shortness of breath and endorses a similar event 5 months ago that quickly resolved spontaneously. He takes perindopril for hypertension. He has a heart rate of 150 beats per minute and blood pressure 124/78 mm Hg. He looks well, is in no distress, has irregularly irregular but otherwise normal heart sounds, and a normal respiratory exam. His electrocardiogram (ECG) shows atrial fibrillation at a rate of 148 beats per minute with no signs of ischemia.

Just the facts: Atrial fibrillation or flutter in patients who are candidates for rate control

“…It is rare for patients to be unstable due to primary acute atrial fibrillation or flutter (defined as blood pressure less than 90 mmHg, altered mental status, cardiac ischemia, or pulmonary edema). An exception is a rapid pre-excitation syndrome such as Wolf-Parkinson-White [1]. For patients who are unstable due to primary acute atrial fibrillation or flutter with onset less than 48 h, urgent electrical cardioversion is indicated.…”