If a patient with atrial fibrillation is unstable, what is the recommended action?

In the case of an unstable patient with atrial fibrillation, the recommended action is to perform cardioversion. Atrial fibrillation can lead to significant hemodynamic instability due to inadequate ventricular filling and inconsistent heart rates, which can result in decreased cardiac output. When a patient is deemed unstable—evidenced by signs such as hypotension, altered mental status, or signs of shock—immediate intervention is necessary to restore normal heart rhythm and stabilize the patient.

Cardioversion can be done either pharmacologically or electrically, but in urgent situations, electrical cardioversion is the preferred method as it provides a rapid and definitive treatment to restore normal sinus rhythm. This procedure delivers a controlled shock to the heart, effectively allowing it to reset and return to a regular rhythm.

Other options, such as increasing medication doses or considering surgical intervention, are not appropriate in acute unstable situations since they may not provide immediate relief or could even exacerbate the patient's condition. Performing a stress test is also inappropriate in this context, as it does not address the urgent need to manage the unstable atrial fibrillation. Therefore, the most effective and timely response to an unstable patient with atrial fibrillation is to proceed with cardioversion.