Atrial Overdrive Pacing or Cardioversion?

[JenHCC]

Pertaining to A-fib and A-flutter, in what instance would you implement atrial overdrive pacing over cardioversion or vice versa? What are the indications for the interventions?

[RN1989]

Have never had a doc order atrial overdrive pacing. Cardioversion is usually ordered for new onset after TEE to check for clots if drug therapy fails.

[estherojin]

In the EP lab, we've paced pts out of A flutter, but generally I believe you can't overdrive pace A fib since it's a disorganized rhythm- for the same reason you can't pace VF, but can overdrive pace VT. During EP studies, if you pace the atrium too fast, you can cause A Fib.

[Zookeeper3]

If I have pacing wires and the pt. is stable and there is time to call the MD for a SVT, on occasion they order override pacing. (Depends on the cardiologist. Usually they've had to do this in the cath lab or at bedside with these patients). Works at times, but it just gives you time to diagnose whats causing it and get treatment started.

If unstable, ansethesia will come to bedside while we cardiovert, by ACLS, but have call out to the MD.

Stable, get anticoagulation, Drug therapy to controll the rate, TEE and conscious sedation at bedside with cardioversion by cardiology.

treatment differs as well if its a cabg or cath with the wires depending on our docs.

Also ---- what estherojin said when it's irregular.