Patient Presentation for
ü Bedside Telemetry
Chest Pain, or
> 110 bpm?
Send to ED
Digestive Health Center Endoscopy Atrial Fibrillation Algorithm
RN should obtain vital signs, assess for related
symptoms and known history of arrhythmia.
Perform brief chart review for any previously
documented cardiac history (i.e., prior EKGs for
comparison) or treatment.
Notify the physician (or anesthesiologist if present)
performing the endoscopic procedure.
If known history and rate well controlled, no need to
confirm with ECG.
In general it is ok to proceed with procedural sedation in
patients with atrial fibrillation that are compensated (no
heart failure or hypotension). Symptoms of heart failure
may include: new or worsening lower extremity edema,
orthopnea, PND, elevated JVP, rales, dyspnea at rest or
inability to climb one flight of stairs.
If patient is tachycardic or hypotension limits
administration of AV nodal blocking agents, it is not
recommended to proceed with the procedure.
Evaluate volume status. If no symptoms of heart failure
and patient appears volume depleted, consider 500 mL
Recommended labs: Sodium, Potassium, Chloride, Total
Carbon Dioxide, BUN, Creatinine, Magnesium, TSH
Provided the above criteria are met, most patients may
undergo an endoscopic procedure. However, if the
physician feels otherwise, he/she may cancel the
procedure with provider follow-up in 5-10 days.
See Dosing Table below for options.
NOTE: Consider contraindications before initiating a beta
blocker (i.e., COPD, steroid-dependent asthma, etc.).
Last revised/reviewed: 08/2015
Contact CCKM for revisions.
Atrial Fibrillation- Adult- Inpatient/Ambulatory Guideline
1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline 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
Heart Rhythm Society. Circulation. 2014
Brief Chart Review & Medical Screening Exam
Obtain 12-lead ECG to assess current heart rhythm
if new onset
blocker or calcium
New onset or
> 110 bpm?
Follow-up with Provider in 5-10 days
See Suggested Follow-up Box (to left)-
Consider metoprolol tartrate (25-50 mg BID) if heart
rate > 110 bpm. If the clinician feels that the patient
needs clinical follow-up in the next 24-48 hours, this
can be expedited via the Cardiology Clinic
Follow-up as needed
with provider managing
NOTE: All patients may be considered for
referral to Cardiology (263-1530)
By Primary Care Provider:
ξ Patients with known AF w/o heart failure or
high risk features previously managed by PCP
Patients with new onset (first occurrence)
ξ Patients with known AF and regularly followed
by cardiologist (or seen by cardiologist within
the last 2 years)
< 110 bpm?
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2015CCKM@uwhealth.org