Algorithm for Atrial Fibrillation

Chronic Atrial Fibrillation

CHADS Score

Atrial Fibrillation

Is goal rhythm or rate control?

  • B-block (EMP or EMAC) or NDHP Ca-block (VD)
  • 3rd line digoxin
  • HR goal is 60-80 @rest; 90-115 duringexertion

When should I anticoagulate?

  • Anticoag if CHADS2 >/=2 to INR of 2-3
  • EXCEPTIONS: RHD, prosthe valves, persistent thrombus or h/o thromboembo (then goal will be 2.5-3.5)
  • CHAD 1 – ASA or warfarin CHAD 0 (lone AF) – ASA or no Tx

 

Sample orders:

  • Admit to telemetry
  • Diagnostics: EKG, Echo, TSH, PT/INR, LE doppler, serum digoxin levels
  • Therapeutics:  anticoagation, rate control, antiarrhytymic drugs
  • Other considerations:  EP consult for ablation
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