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Source: Institute for Clinical Systems Improvement (ICSI). Atrial fibrillation. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 October. 62 p. Atrial Fibrillation A = Annotation Five key management steps for Atrial fibrillation: SALT-E. S - stabilize. A - assess. L - label for stratification of treatment options. T - treat. E - educate. Patient presentation: symptoms or physical findings suggestive of A Fib / A Flutter or incidental ECG finding. A ECG confirms A Fib and / or A Flutter? A Out of guideline *Look for other causes. Is pre-excitation/WPW present? A Fib with pre-excitation/WPW syndrome: *Stabilize patient. *Assess for potentially reversible causes/comorbidities. *Electrophysiology consult. A Stabilize patient: *Hemodynamic stabilization. *Acute rate control. A Assess for potentially reversible causes and comorbidities: *Hypertension. *Coronary ischemia. *Heart failure. *Obstructive sleep apnea. *Other. A Initiate treatment based on Label First detected episode duration known greater than or equal to 48 hrs or duration unknown. A Recurrent A Fib *Paroxysmal. *Persistent. *Permanent. Recurrent A Flutter Assess patient for short-term anticoagulation Assess patient for surgical options concurrent with cardiac surgery Treatment: Electrophysiology consult Treatment options: A. Conventional anticoagulation and cardioversion. B. Chronic rate control and chronic anticoagulation Assess patient for chronic anticoagulation. A Patient Education Assess patient for rate control agents. A Age less than or equal to 65? A Consultation with a physician with cardiology expertise for treatment options: *Intermittent cardioversion. *Antiarrythmics. *Electrophysiology consult. Inadequate rate control? A -Cardiac pacing. -Catheter-based ablative therapies. -Pulmonary vein isolation techniques. -Surgical maze procedure. A Inadequate symptom control? A Other concerns? A *Aggressive management of patient comorbidities (hypertension). *Monitor for recurrence. *Patient Education. A All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.