<< Atrial Fibrillation: Management Strategies In The Emergency Department

Risk Management Pitfalls For Atrial Fibrillation

  1. “The patient denied any chest pain, so I sent her home after she spontaneously cardioverted.”
    Unfortunately, the patient was a 62-year-old female with diabetes who had a prior history of myocardial infarction. Had you compared her prior ECG, you would have noted new ischemic changes. Although she spontaneously converted, ECG changes and significant cardiac risk factors should have prompted an admission to further evaluate for ischemia.
  2. “The ibutilide worked great. The patient felt much better and wanted to go home immediately.”
    While ibutilide works to convert AF/AFL approximately 40% to 50% of the time, it has significant risks—most notably an 8% risk of torsades de pointes and other ventricular tachyarrhythmias, which may be mitigated by pretreatment with IV magnesium sulfate. Use of this drug requires a 4-hour period of monitoring after administration.

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