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. Author manuscript; available in PMC: 2024 May 20.
Published in final edited form as: J Am Coll Cardiol. 2023 Nov 30;83(1):109–279. doi: 10.1016/j.jacc.2023.08.017

FIGURE 22.

FIGURE 22

Treatment Algorithm for Pharmacological Conversion of AF to Sinus Rhythm *In the absence of preexcitation. †First dose administered in a facility that can provide continuous electrocardiographic monitoring and cardiac resuscitation because of the potential for proarrhythmia or postconversion bradycardia. ‡IV amiodarone requires several hours for efficacy; ibutilide is generally effective in 30 to 90 min but carries a higher risk of QT interval prolongation and torsades de pointes. §Recommend avoidance of IV procainamide for patients initially treated with amiodarone or ibutilide to avoid excessive QT interval prolongation and torsades de pointes. Rather, procainamide may be considered for patients for whom amiodarone and ibutilide are not considered optimal as first-line drugs. Colors correspond to Table 2. AF indicates atrial fibrillation; HFrEF, heart failure with reduced ejection fraction; IV, intravenous; LV, left ventricular; LVEF, left ventricular ejection fraction.