| Scenario | Decision | Management Action | SBA Key Fact |
| | | |
| AF/Flutter is UNSTABLE (Shock, Ischaemia, HF) | Urgent Synchronized Cardioversion | 120−150 J (biphasic) for AF. 70−120 J for Flutter. | Do not delay for anticoagulation! |
| | | |
| AF Duration <48 hours (Stable) | Rhythm Control Preferred (Cardioversion) | Pharmacological (e.g., Flecainide) or Electrical cardioversion is safe, followed by 4 weeks of anticoagulation. | Anticoagulation must start before discharge. |
| | | |
| AF Duration >48 hours or Unknown (Stable) | Rate Control Preferred (Delayed Cardioversion) | Rate Control: β-blocker (e.g., Metoprolol) or CCB (e.g., Diltiazem). Avoid CCB in Heart Failure. | Patient must be anticoagulated for 3 weeks prior to planned cardioversion. |
| | | |
| Anticoagulation | Stroke Risk | Use CHA2DS2VASc score for risk stratification. | AF is a major risk factor for Stroke. DOACs are generally first-line unless mechanical valve or Mitral Stenosis (→Warfarin). |
