Atrial fibrillation pharmacological cardioversion: Difference between revisions

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==Overview==
==Overview==
Chemical cardioversion refers to restoring the heart's rhythm to normal through pharmacological agents such as [[amiodarone]], [[propafenone]], and [[flecainide]]. Such medications work by altering the heart’s electrical properties to suppress the abnormal  heart rhythms and restore a normal rhythm, and can be administered orally or intravenously. The treatment can be carried either in an in-patient or out-patient setting.
Chemical cardioversion refers to restoring the heart's rhythm to normal through pharmacological agents such as [[amiodarone]], [[propafenone]], and [[flecainide]]. Such medications work by altering the heart’s electrical properties to suppress the abnormal  heart rhythms and restore a normal rhythm, and can be administered orally or intravenously. The treatment can be carried either in an in-patient or out-patient setting.


==2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial                     Fibrillation (DO NOT EDIT)<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>==
==2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary (DO NOT EDIT)<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=Craig T.|last2=Wann|first2=L. Samuel|last3=Alpert|first3=Joseph S.|last4=Calkins|first4=Hugh|last5=Cleveland|first5=Joseph C.|last6=Cigarroa|first6=Joaquin E.|last7=Conti|first7=Jamie B.|last8=Ellinor|first8=Patrick T.|last9=Ezekowitz|first9=Michael D.|last10=Field|first10=Michael E.|last11=Murray|first11=Katherine T.|last12=Sacco|first12=Ralph L.|last13=Stevenson|first13=William G.|last14=Tchou|first14=Patrick J.|last15=Tracy|first15=Cynthia M.|last16=Yancy|first16=Clyde W.|title=2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary|journal=Journal of the American College of Cardiology|year=2014|issn=07351097|doi=10.1016/j.jacc.2014.03.021}}</ref>==
 
===Rhythm Control===


===Pharmacological Cardioversion of Atrial Fibrillation (DO NOT EDIT)<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>===
====Pharmacological Cardioversion: Recommendations====


{|class="wikitable"
{|class="wikitable" style="width: 80%;"
|-
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Administration of [[flecainide]], [[dofetilide]], [[propafenone]], or [[ibutilide]] is recommended for pharmacological [[cardioversion]] of [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Flecainide, dofetilide, propafenone, and intravenous ibutilide are useful for pharmacological cardioversion of AF or atrial flutter provided contraindications to the selected drug are absent. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|}
|}


{|class="wikitable"
{|class="wikitable" style="width: 80%;"
|-
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III: Harm]]
|-
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Digoxin]] and [[sotalol]] may be harmful when used for pharmacological [[cardioversion]] of [[AF]] and are not recommended. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Dofetilide therapy should not be initiated out of hospital owing to the risk of excessive QT prolongation that can cause torsades de pointes. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' [[Quinidine]], [[procainamide]], [[disopyramide]], and [[dofetilide]] should not be started out of hospital for conversion of [[AF]] to [[sinus rhythm]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
|}


{|class="wikitable"
{|class="wikitable" style="width: 80%;"
|-
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Administration of [[amiodarone]] is a reasonable option for pharmacological [[cardioversion]] of [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Administration of oral amiodarone is a reasonable option for pharmacological cardioversion of AF. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' A single oral bolus dose of [[propafenone]] or [[flecainide]] (“pill-in-the-pocket”) can be administered to terminate persistent [[AF]] outside the hospital once treatment has proved safe in hospital for selected patients without sinus or [[AV node]] dysfunction, [[bundle branch block]], [[QT-interval prolongation]], the [[Brugada syndrome]], or [[structural heart disease]]. Before [[antiarrhythmic medication]] is initiated, a [[beta blocker]] or non [[dihydropyridine]] [[calcium channel antagonist]] should be given to prevent rapid AV conduction in the event [[atrial flutter]] occurs. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Propafenone or flecainide (“pill-in-the-pocket”) in addition to a beta blocker or nondihydropyridine calcium channel antagonist is reasonable to terminate AF outside the hospital once this treatment has been observed to be safe in a monitored setting for selected patients. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Administration of [[amiodarone]] can be beneficial on an outpatient basis in patients with paroxysmal or persistent [[AF]] when rapid restoration of [[sinus rhythm]] is not deemed necessary. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
|}


{|class="wikitable"
==Sources==
|-
 
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
* [https://content.onlinejacc.org/article.aspx?articleID=18542302014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary]<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=Craig T.|last2=Wann|first2=L. Samuel|last3=Alpert|first3=Joseph S.|last4=Calkins|first4=Hugh|last5=Cleveland|first5=Joseph C.|last6=Cigarroa|first6=Joaquin E.|last7=Conti|first7=Jamie B.|last8=Ellinor|first8=Patrick T.|last9=Ezekowitz|first9=Michael D.|last10=Field|first10=Michael E.|last11=Murray|first11=Katherine T.|last12=Sacco|first12=Ralph L.|last13=Stevenson|first13=William G.|last14=Tchou|first14=Patrick J.|last15=Tracy|first15=Cynthia M.|last16=Yancy|first16=Clyde W.|title=2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary|journal=Journal of the American College of Cardiology|year=2014|issn=07351097|doi=10.1016/j.jacc.2014.03.021}}</ref>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Administration of [[quinidine]] or [[procainamide]] might be considered for pharmacological [[cardioversion]] of [[AF]], but the usefulness of these agents is not well established. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}


==Sources==
*[http://content.onlinejacc.org/cgi/reprint/48/4/e149.pdf ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>
*[http://content.onlinejacc.org/cgi/reprint/48/4/e149.pdf ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>


Revision as of 05:56, 30 March 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.

Overview

Chemical cardioversion refers to restoring the heart's rhythm to normal through pharmacological agents such as amiodarone, propafenone, and flecainide. Such medications work by altering the heart’s electrical properties to suppress the abnormal heart rhythms and restore a normal rhythm, and can be administered orally or intravenously. The treatment can be carried either in an in-patient or out-patient setting.

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary (DO NOT EDIT)[1]

Rhythm Control

Pharmacological Cardioversion: Recommendations

Class I
"1. Flecainide, dofetilide, propafenone, and intravenous ibutilide are useful for pharmacological cardioversion of AF or atrial flutter provided contraindications to the selected drug are absent. (Level of Evidence: A) "
Class III: Harm
"1. Dofetilide therapy should not be initiated out of hospital owing to the risk of excessive QT prolongation that can cause torsades de pointes. (Level of Evidence: B) "
Class IIa
"1. Administration of oral amiodarone is a reasonable option for pharmacological cardioversion of AF. (Level of Evidence: A) "
"2. Propafenone or flecainide (“pill-in-the-pocket”) in addition to a beta blocker or nondihydropyridine calcium channel antagonist is reasonable to terminate AF outside the hospital once this treatment has been observed to be safe in a monitored setting for selected patients. (Level of Evidence: B) "

Sources

References

  1. ↑ 1.0 1.1 January, Craig T.; Wann, L. Samuel; Alpert, Joseph S.; Calkins, Hugh; Cleveland, Joseph C.; Cigarroa, Joaquin E.; Conti, Jamie B.; Ellinor, Patrick T.; Ezekowitz, Michael D.; Field, Michael E.; Murray, Katherine T.; Sacco, Ralph L.; Stevenson, William G.; Tchou, Patrick J.; Tracy, Cynthia M.; Yancy, Clyde W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary". Journal of the American College of Cardiology. doi:10.1016/j.jacc.2014.03.021. ISSN 0735-1097.
  2. ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
  3. ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  4. ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199


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