Amiodarone for Atrial Arrhythmia

[ERDoc]

The turbulent flow through the non-contracting atria cause an increased risk of forming blood clots. If you convert the rhythm and the atria start contracting normally, the clots can break lose and end up in the brain, lungs, kidneys, etc. Generally speaking, in the hospital if someone has been in afib more than 48 hours or the duration is not known we anticoagulate and control the rate. They can be safely converted once an echo has confirmed that there is no clot in the atria.

 

[systemet]

I just want to add another voice to the "be careful of treating atrial fibrillation" bandwagon. We carry metoprolol for this, and I use it very very rarely. It's typically in younger patients, who don't have a history of chronic fibrillation, who can identify a clear, recent onset of symptoms that are reasonably attributable to a conversion into a.fib, and have relatively fast rates.

I have seen many paramedics forget that a rapid atrial fibrillation is often compensation for, or secondary to, pain, fever, volume depletion, or hypoxia, with disastrous consequences. Especially in patients with baseline heart disease.

While I've found a niche for it in my practice as a paramedic, I could certainly work without it. It's nice to have an agent that offers a potential for rate control without rhythm conversion -- but sometimes cardioversion, rhythm conversion and a risk of embolus is superior to medication and decompensation of heart failure that may take hours to resolve. These are often decisions that are better deferred to the ER.

Edit: grammar and spelling.