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 […]

Alcohol Abstinence in Drinkers with Atrial Fibrillation

Methodology: 5/5 Usefulness: 3.5/5 Voskoboinik A, et al. N Engl J Med. 2020 Jan 2;382(1):20-28.  Editorial: A Sober Reality? Alcohol, Abstinence, and Atrial Fibrillation. Question/Methods: Among adults who consume ≥10 drinks/week with symptomatic paroxysmal or persistent atrial fibrillation successfully converted to sinus rhythm, investigators conducted a multicentre RCT of control versus alcohol abstinence. Two blinded cardiologists reviewed tracings from intensive […]

Electrical vs Chemical Cardioversion in ED patients with Atrial Fibrillation (RAFF2)

RAFF2 Ian Stiell and colleagues are back at it with atrial fibrillation; The RAFF2 trial (Electrical versus Chemical cardioversion for Emergency Department patients with Atrial Fibrillation (RAFF2); A partial factorial randomized trial) was published in The Lancet this week. Acute atrial fibrillation is an irregular dysrhythmia that should be treated within 48 hours to avoid significant complications such as stroke […]

Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation

Journal Club Summary Methodology Score: 4/5 Usefulness Score: 2/5 Pluymaekers NAHA, et al. N Engl J Med. 2019 Mar 18.  Editorial: The RACE to Treat Atrial Fibrillation in the Emergency Department.  Question and Methods: This multicenter, randomized, open-label, non-inferiority trial compared delayed vs early cardioversion for emergency department patients with recent-onset, symptomatic atrial fibrillation. Findings: Sinus rhythm at four weeks […]

An Update: Rate Control in Atrial Fibrillation

In this post, we will discuss updates and controversies surrounding rate control in Afib, specifically we will: Review the new 2017 CAEP Afib best practices guidelines Review Tachycardia Induced Cardiomyopathy Review Afib and Type 2 ACS Discuss the identification and management of secondary Afib 2017 CAEP AAF Best Practices Guideline Update: Risk Stratification: Unstable AAF (Acute Afib) is very rare: […]

2014 Canadian Guidelines for AF Management: Part 3: Unstable Patients with AF

We continue to discuss the latest recommendations for ED management of atrial fibrillation (AF) as presented in the newly published 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. The Guidelines PDF can be downloaded from the CCS website at 2014 Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation   Beware of Unstable […]

2014 Canadian Guidelines for AF Management: Part 2: ED Algorithm and Risk Stratification for Stroke

We continue to discuss the latest recommendations for ED management of atrial fibrillation (AF) as presented in the newly published 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. The Guidelines PDF can be downloaded from the CCS website at 2014 Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation   Clinical experience and […]

2014 Canadian Guidelines for AF Management: Part 1: Introduction and CCS “CHADS-65” Algorithm

In this and subsequent postings we will discuss the latest recommendations for ED management of atrial fibrillation (AF) as presented in the newly published 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. The Guidelines PDF can be downloaded from the CCS website at 2014 Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation […]

Efficacy and safety of the novel oral anticoagulants in atrial fibrillation: a systematic review and meta-analysis of the literature

Journal Club Summary Methodology Score: 4.5/5              Usefulness Score: 3/5   Dentali F, Riva N, Crowther M, Turpie AG, Lip GY, Ageno W. Circulation. 2012 Nov 13;126(20):2381-91. Article Link   This was a systematic review and meta-analysis of 12 phase II/III RCTs which found that using New Oral Anticoagulants (NOACs: dabigatran, rivaroxaban, apixaban, edoxaban) over warfarin in patients with AF reduced […]

Predictive accuracy of ST depression during rapid atrial fibrillation on the presence of obstructive coronary artery disease

Journal Club Summary  Methodology: 3/5      Usefulness: 3/5 Pradhan R, Chaudhary A, Donato AA. Am J Emerg Med. 2012 Sep;30(7):1042-7 Abstract Link   This was a retrospective cohort study of 127 patients that found no association between ST depression during rapid atrial fibrillation and obstructive CAD on cardiac catheterization.  Because of possible selection bias in retrospectively identifying patients using catheterization billing without […]