By vgreene, 15 January, 2015 Postconversion pill-in-pocket prn option: propafenone/flecainide + BB/non-DHP-CCB (diltiazem/verapamil), once proven safe in monitored setting, reasonable to terminate out-pt AF [IIa/B]
By vgreene, 15 January, 2015 Pharmacologic cardioversion<sup>18</sup> + peri-procedural anticoagulation<sup>17</sup> + rate-control tx: flecainide, dofetilide, propafenone, IV ibutilide [I/A] or amiodarone<sup>18</sup> [IIa/A]
By vgreene, 15 January, 2015 DC cardiovert [I/B] + peri-procedural anticoagulation.<sup>17</sup> Repeat/serial attempts<sup>17</sup> based on sinus rhythm duration, sx, pt preference<sup>17</sup> +/- rate-control tx [IIa/C]
By vgreene, 15 January, 2015 Restore sinus rhythm<sup>15</sup> via DC cardioversion, antiarrhythmic drug, or RF cath ablation; +/- rate control. No long-term antithrombotic tx (unless HCM).<sup>16</sup> Correct underlying causes [I/C].
By vgreene, 15 January, 2015 Control heart rate;<sup>5</sup> adjust to control rate during exertion [I/C]
By vgreene, 15 January, 2015 If drug rate control inadequate/sx persist, use rhythm control.<sup>9</sup> If drug tx inadequate and rhythm control not achievable: AV-node ablation<sup>9</sup> + pacing [IIa/B]
By vgreene, 15 January, 2015 If HF w/ rest/exercise HR not controlled w/ BB, CCB (in HFpEF) or dig (alone or combined): consider amiodarone<sup>8</sup> [IIb/C]
By vgreene, 15 January, 2015 If BB/CCB failure/intolerance, use dig/combos:<sup>8</sup> Dig controls resting HR in HFrEF [I/C]. Combine BB w/ other drugs, incl. dig; titrate to avoid bradycardia. Dig may be combined w/ BB or CCB [IIa/B] incl. for HF pts (avoid CCB if HFrEF) [IIa/B]
By vgreene, 15 January, 2015 BB/CCB (diltiazem/verapamil)<sup>8</sup> is 1st line [I/B]. If COPD, CCB [I/C]; if hyperthyroid, BB [I/C], if can’t be used, CCB [I/C]; if systolic HF, BB. Resting goal HR ≤80 [IIa/B]; if no sx & preserved LV systolic fxn, consider lenient ≤110 [IIb/B]