Decision
Are any of the following present?
- Wide, bizarre QRS
- History of Wolff-Parkinson-White syndrome
- Delta wave on ECG
- Ventricular rate >220 beats/min
Yes
- Perform synchronized cardioversion (Class I) with sedation, if hemodynamically unstable
- Medication
- Procainamide 100 mg IV q5-10 min, max 17 mg/kg (Class I)
- Amiodarone 150 mg IV over 10 min (Class III)
Hemodynamic instability secondary to AF