Paakkinen S, Furberg CD, Wolpert C, Patients with chronic atrial fibrillation (including paroxysmal fibrillation) and at least one risk factor for thromboembolism should be considered for chronic anticoagulation.Three large, prospective, randomized trials currently under way address the question of rate control versus rhythm control. The dilutions listed are conservative guidelines that can be used in non-acute conditions. According to the Framingham Heart Study,Atrial fibrillation is associated with significant morbidity, including an increased susceptibility to embolic stroke. Kuchar DL, Conversion of recent-onset atrial fibrillation by a single oral loading dose of propafenone or flecainide. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Torsades de pointes remains a significant risk, so the safety of this method has not been established. Botto GL, The conversion rate is reported to be up to 60 percent. Paroxysmal atrial fibrillation is defined as recurrent episodes of spontaneously terminating atrial fibrillation. In patients who tolerate full 15 mg dose, oral lopressor 50mg po q6h should be started 15 min after last IV dose x 48 hours. During the intravenous administration of metoprolol tartrate, blood pressure, heart rate, and electrocardiogram should be carefully monitored. Up to 70 percent of all conversions occur within 20 minutes of infusion.Side effects include significant QT prolongation with sustained polymorphic ventricular tachycardia (torsades de pointes) in 1.7 percent of patients and nonsustained polymorphic ventricular tachycardia in 2.6 percent of patients.In summary, class IA and class IC agents are effective for acute termination of atrial fibrillation, with conversion rates of 60 to 80 percent at eight hours after treatment. Myerburg RJ, External direct current (DC) cardioversion is the most effective means of converting atrial fibrillation to sinus rhythm. Arnau JM, Lenzi T, Smith VE, Perry KT, May switch to oral dosing (50 to 100mg po q6h) after IV bolus therapy. Kay GN, Kirchhof CJ, Left atrial chamber and appendage function after internal atrial defibrillation: a prospective and serial transesophageal echocardiographic study. IV therapy permits rapid control of HR and contractility. Rabahieh R, Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. Dunn G, Malenka DJ, Fuster V, Baedeker F. Marchlinski FE. In patients who tolerate the full intravenous dose (15 mg), metoprolol tartrate tablets, 50 mg every 6 hours, should be initiated 15 minutes after the last intravenous dose and continued for 48 hours. Tieleman RG, et al. Risk for clinical thromboembolism associated with conversion to sinus rhythm in patients with atrial fibrillation lasting less than 48 hours. Capucci A, Time of occurrence, duration, and ventricular rate of paroxysmal atrial fibrillation: the effect of digoxin. Persistent atrial fibrillation is defined by persistence of the arrhythmia until cardioversion is performed. Wood MA, Skoularigis J, Risks and benefits of antiarrhythmic therapy. 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