Atrial Fibrillation with Acute or Worsening Haemodynamic Instability

Clinical Scenario

This protocol covers atrial fibrillation presenting with acute or worsening haemodynamic instability — a time-sensitive situation where the arrhythmia is driving or contributing to circulatory compromise and requires immediate intervention.

Treatment Approach

Emergency electrical cardioversion is the primary intervention to restore sinus rhythm and improve immediate patient outcomes. For selected patients in whom haemodynamic instability or severely reduced cardiac function is a consideration, intravenous pharmacological support may also play a role in acute management.

Full agent selection, sequencing, and dosing guidance is in the complete protocol below ↓

Treatment Target

The primary clinical goal in this setting is:

Restoration of sinus rhythm

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehae176

Electrical cardioversion is recommended in AF patients with acute or worsening haemodynamic instability to improve immediate patient outcomes.

In patients with acute or worsening haemodynamic instability thought to be caused by AF, rapid electrical cardioversion is recommended.

Intravenous amiodarone, digoxin, or landiolol may be considered in patients with AF who have haemodynamic instability or severely depressed LVEF to achieve acute control of heart rate.

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