If patient stable and on warfarin - do not interfere.
  • If atrial fibrillation present for more than one year, cardioversion usually not done.
  • If atrial fibrillation present for less than one year, consider cardioversion.
  • If atrial fibrillation uncontrolled, use digoxin.
  • What is cause of atrial fibrillation?
    • ECG
    • CXR
    • TFT
    • Echocardiography determines whether patient should be commenced on aspirin or warfarin.
Risk factors - so more suitable for warfarin:
  • Age > 65
  • Hypertension
  • LV dysfunction or failure
  • Previous thromboembolism
  • Diabetes
  • Coronary artery disease

 

  BHF factfiles

NICE atrial fibrillation guidelines

Atrial fibrillation emergency resuscitation

Starting digoxin

Loading dose

15mcg per kg of estimated lean body weight, given in 3 divided doses at 6 hour intervals

eg: 50kg woman requires 750mcg = 250mcg x3 doses 6 hours apart.

If ventricular rate not slowed and no signs of toxicity, try another 5mcg per kg

Maintenance

Creatinine clearance (ml/min) Daily maintenance dose as a fraction of effective loading dose
100 1/3
50 1/4
25 1/5
10 1/6
0 1/7

Reference: BHF factfile 7/2001