Cardiology

Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomised trial.

Methodology: 4.5/5
Usefulness: 4/5

Stiell IG, et al. Lancet. 2020 Feb 1;395(10221):339-349

Editorial: Atrial fibrillation cardioversion in the emergency department. 

Question and Methods: This partial factorial randomized trial aimed to determine which rhythm control strategy was superior; procainamide followed by electrical cardioversion if needed compared with electrical cardioversion alone. It also sought to determine whether anterolateral or antero-posterior pad placement was superior.

Findings: There was no difference in the rate of conversion to sinus rhythm between the drug-shock and shock only groups which were both highly successful (96% and 92% respectively, p 0.066). There was also no significant difference in cardioversion rates based on pad placement.

Limitations: The only chemical cardioversion agent used was procainamide.

Interpretation: The evidence equally supports drug-shock and shock only strategies for achieving rhythm control in acute atrial fibrillation. For most patient’s, the drug-shock approach may be optimal given lower resource utilization.

By: Dr. Michael Hale

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.

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