✨ Atrial Fibrillation with Rapid Ventricular Response: Rhythm Control - #MEDSHED
Amiodarone IV
Mechanism of Action (MOA)
Amiodarone is a Class III antiarrhythmic medication that works by inhibiting sodium, potassium, and calcium channels. Additionally, it acts as an adrenergic blocker acting on alpha and beta receptors.
Dosage
The recommended dosage of Amiodarone IV is as follows:
Initial Dose: 150 mg IV administered over 10 minutes.
Continuous Infusion: Followed by 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours, with a cumulative loading dose of up to 10 grams.
Repeat Bolus: Consider repeating the bolus dose as needed.
Precautions and Monitoring
When administering Amiodarone IV, it is crucial to monitor for:
QRS Widening: Indicates potential arrhythmogenic effects.
QTc Prolongation: Risk of Torsades de Pointes.
Hypotension: Particularly with rapid infusion due to the diluent.
The "Pill in Pocket" Approach for Arrhythmia
Mechanism of Action
This approach utilizes Class IC antiarrhythmic agents, which are potent sodium channel blockers, to manage arrhythmias.
Flecainide
Dosage: 200 mg for patients weighing less than 70 kg; 300 mg for those over 70 kg.
Administration: Taken orally at the onset of symptoms. Do not exceed 300 mg in a day.
Propafenone
Dosage: 450 mg for patients weighing less than 70 kg; 600 mg for those over 70 kg.
Administration: Taken orally at the onset of symptoms. Maximum one dose per 24 hours.
Precautions and Monitoring
Key points to monitor include:
QRS Widening: Indicates proarrhythmic potential.
Onset of Action: These medications have a slower onset, peaking around 3 hours.
Electrical Cardioversion
Mechanism of Action
Electrical cardioversion utilizes shock waves to prolong the refractoriness of myocardial tissue, effectively resetting the heart's rhythm.
Dosage
Shock Energy: 200 - 360 Joules., repeat as necessary.
Precautions and Monitoring (for Stable Patients)
Sedation: Administer with amnestic properties for patient comfort.
Anticoagulation: Required for a minimum of 3 weeks post-procedure.
ACLS Protocol: Follow if the patient loses pulse during the procedure.