Table 6 Recommendations in the management of atrial fibrillation in acute myocardial infarction
From: How to manage various arrhythmias and sudden cardiac death in the cardiovascular intensive care
CLASS I |
 1. Direct-current cardioversion is recommended for patients with severe hemodynamic compromise or intractable ischemia, or when adequate rate control cannot be achieved with pharmacological agents in patients with acute Ml and AF or AFL. (Level of Evidence: C) |
 2. Intravenous administration of amiodarone is recommended to slow a rapid ventricular response to AF and improve LV function in patients with acute Ml. (Level of Evidence: C) (Out of insurance coverage) |
 3. Intravenous beta blockers and nondihydropyridine calcium antagonists are recommended to slow a rapid ventricular response to AF in patients with acute Ml who do not display clinical LV dysfunction, bronchospasm, or AV block. (Level of Evidence: C) |
 4. For patients with AF and acute Ml, administration of unfractionated heparin by either continuous intravenous infusion or intermittent subcutaneous injection is recommended in a dose sufficient to prolong the activated partial thromboplastin time to 1.5 to 2.0 times the control value, unless contraindications to anticoagulation exist. (Level of Evidence: C) |
CLASS lla |
 Intravenous administration of digitalis is reasonable to slow a rapid ventricular response and improve LV function in patients with acute Ml and AF associated with severe LV dysfunction and HF. (Level of Evidence: C) |
CLASS III |
 The administration of class IC antiarrhythmic drugs is not recommended in patients with AF in the setting of acute Ml. (Level of Evidence: C) |