During general anesthesia, a patient develops atrial fibrillation with rapid ventricular response and hypotension. What is the most appropriate treatment?
- (A) Intravenous adenosine
- (B) Intravenous beta-blockers
- (C) Synchronized cardioversion ✓
- (D) Intravenous calcium channel blockers
In the scenario described, a patient undergoing general anesthesia develops atrial fibrillation with rapid ventricular response and hypotension. The most appropriate treatment in this acute situation is (C) Synchronized cardioversion.
Explanation:
- Atrial Fibrillation with Rapid Ventricular Response: Atrial fibrillation (AF) is characterized by disorganized electrical activity in the atria, leading to an irregular and often rapid heart rate. When accompanied by a rapid ventricular response (RVR), it can significantly compromise cardiac output, especially if the patient is hypotensive.
- Hypotension: The presence of hypotension indicates that the patient’s perfusion is compromised, which necessitates immediate intervention to stabilize hemodynamics.
- Synchronized Cardioversion: This procedure involves delivering an electrical shock to the heart at a specific point in the cardiac cycle, which can restore normal sinus rhythm effectively. It is particularly indicated in cases where AF leads to hemodynamic instability, as seen in this patient.
- Other Options:
- (A) Intravenous adenosine is primarily used for paroxysmal supraventricular tachycardia and would not be effective for atrial fibrillation.
- (B) Intravenous beta-blockers can help control heart rate but may not be sufficient alone in the setting of hypotension and acute AF.
- (D) Intravenous calcium channel blockers can also help manage heart rate but similarly may not address the immediate need for stabilization due to hypotension.
Given these considerations, synchronized cardioversion is the most appropriate and urgent treatment option for a patient experiencing atrial fibrillation with rapid ventricular response and hypotension during general anesthesia.
