image: Partially blinded randomized controlled study of , adults 18-75 years, CHADS2 0 or 1, AFib duration <48h. Excluding hemodynamic instability, acute underlying illness, cardiac procedure two weeks prior, intoxicated/withdrawing. view more
Credit: Kirsty Challen, B.SC., MBCHB, MRES, PH.D., Lancashire Teaching Hospitals, United Kingdom
DES PLAINES, IL -- A multicenter randomized controlled clinical trial confirms that both chemical-first and electrical-first approaches are effective strategies for acute atrial fibrillation; however, an electrical-first strategy results in a significantly shorter emergency department (ED) length of stay. The study findings are published in the September 2019 issue of Academic Emergency Medicine (AEM), a journal of the Society for Academic Emergency Medicine (SAEM).
The lead author of the study is Frank X. Scheuermeyer, MD, MHSc, program head, clinical associate professor, and director of research in the Department of Emergency Medicine at St. Paul's Hospital and the University of British Columbia, Vancouver.
The trial results showed that in uncomplicated ED atrial fibrillation patients of less than 48 hours, a significantly greater proportion of ED patients were discharged from the ED within four hours when managed with an electrical-first cardioversion strategy, compared to a chemical?first cardioversion strategy. In addition, the median LOS was shorter by 1.2 hours for the electrical?first group.
The findings add to the literature by comparing two accepted treatments, measuring important outcomes--including patient-reported results--and demonstrating that these patients, irrespective of initial management strategy, are safe; have minimal discomfort after their ED visit; and have an acceptable QoL at 3 and 30 days.
The study may assist clinicians by demonstrating that the electrical-first strategy may restore sinus rhythm more quickly. The results should encourage clinicians to initially consider an electrical-first approach for such patients.
Commenting on the study is Editor-in-Chief of the Canadian Journal of Emergency Medicine, Ian G. Stiell, MD, MSc, a distinguished professor and senior scientist in the Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa:
"This study confirms that both chemical-first and electrical-first approaches are effective strategies for acute atrial fibrillation. Immediate rhythm control by ED physicians allows rapid discharge of patients and early return to normal activities. Whether drug first or shock first should be determined by patient or physician preference."
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ABOUT ACADEMIC EMERGENCY MEDICINE
Academic Emergency Medicine, the monthly journal of Society for Academic Emergency Medicine, features the best in peer-reviewed, cutting-edge original research relevant to the practice and investigation of emergency care. The above study is published open access and can be downloaded by following the DOI link: 10.1111/acem.13669. Journalists wishing to interview the authors may contact Stacey Roseen at sroseen@saem.org.
ABOUT THE SOCIETY FOR ACADEMIC EMERGENCY MEDICINE
SAEM is a 501(c)(3) not-for-profit organization dedicated to the improvement of care of the acutely ill and injured patient by leading the advancement of academic emergency medicine through education and research, advocacy, and professional development. To learn more, visit saem.org.
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