What is the primary treatment for hemodynamically unstable atrial fibrillation?

In the case of hemodynamically unstable atrial fibrillation, the primary treatment is synchronized cardioversion. This method is critical because it addresses the immediate concern of unstable hemodynamics, which can result from rapid and irregular heart rhythms that compromise cardiac output. Synchronized cardioversion delivers a controlled electric shock to the heart, effectively restoring a normal rhythm and stabilizing the patient's condition.

The urgency of correcting the rhythm is essential, particularly when the patient exhibits symptoms such as hypotension, altered mental status, or chest pain, which indicate a high risk for further cardiovascular complications. Synchronized cardioversion is performed with careful timing to ensure that the shock occurs during a specific phase of the cardiac cycle, thereby minimizing the risk of inducing ventricular fibrillation.

Other options, such as medication adjustment or direct oral anticoagulation, are typically employed for rate control or thromboembolic prevention in stable patients. Cardiac catheterization is more relevant for diagnosing or treating structural heart issues rather than managing acute rhythm disturbances. Thus, synchronized cardioversion stands out as the immediate and effective measure in this emergent scenario.