The Living Guidelines: Pharmacological Cardioversion of Atrial Fibrillation: Suggest Revisions to the CLASS IIa Guidelines

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Class IIa Guidelines

 * 1) Administration of amiodarone is a reasonable option for pharmacological cardioversion of AF. (Level of Evidence: A)
 * 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. (Level of Evidence: C)
 * 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. (Level of Evidence: C)