II. Indications: Atrial Fibrillation Cardioversion

  1. Time to Cardioversion: 1 hour
  2. Conversion Rate: 33-45% (60% in Atrial Flutter)

III. Mechanism

  1. Class III Antiarrhythmic

IV. Dose

  1. Initial
    1. Under 60 kg: 0.01 mg/kg IV over 10 min
    2. Over 60 kg: 1 mg IV over 10 min
  2. Subsequent
    1. May repeat once after 10 min if not converted

V. Adverse Effects

  1. Observe QT Interval
  2. Evaluate Serum Potassium and Magnesium
  3. Significantly proarrhythmic
    1. Ventricular Tachycardia or fibrillation risk: 1-2%
    2. Requires EKG monitoring for 4 hours after dose

VI. Precautions

  1. Most expensive Antiarrhythmic
  2. Cardiac monitor on starting agent
    1. Continue for minimum of 4 hours
    2. Continue until QT Interval normalizes

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