GDS2008 wrote:
When presented with a case of AF, go in this sequence:
1) Hemodynamically stable or not ==> If not stable, do not think about anything else. Go straight to electric cardioversion (keeping the patient alive/ABC is much more important than anything else. Cardiovrsion can be achieved by 2 methods: Electric or chemical. Chemical cardioversion (with anti-arrhythmic drugs take time and therefore cannot be opted here when the patient is unstable. Therefore the only option in this case will be electric cardioversion)

2. Patient is hemodynamically stable. Now what==> Look at the duration of AF (i.e. decide whether acute <48 hours or chronic >48 hours). If the duration is unknown, assume that it is chronic. In all cases of heart arrhythmia, the best treatment is to convert to sinus rhythm. AF is no exception and in cases of acute AF convert the patient to sinus rhythm (ny cardioversion, now u can choose between electric or chemical, simple nothing else needed). However, with chronic AF this is not possible. This is because chronic AF results in stasis of blood in the atria (as there is no atrial contraction) whihc results in formation of blood clots. If ur convert the patient to sinus rhythm now, the clot may dislodge and the patient may end up with a stroke. Therefore, rate control (to control the rapid ventricualr rate) is the next best step in cases of chronic AF. This is best achieved with verapamil. This is how AF is managed in the ER (emergency setting, leave the details about when to anti-coagulate and other stuff to cardiologists)
Hope this helps!