Emergency Department Treatment of Atrial Fibrillation in Canada, Where Cardioversion Is Common

For atrial fibrillation or flutter with onset within 48 hours, the tide has been turning in recent years from rate control to rhythm control. Canadian investigators conducted a prospective cohort study to determine 30-day outcomes among patients treated for atrial fibrillation or flutter in six academic emergency departments (EDs). The composite outcome of adverse events included death, stroke, acute coronary syndrome, heart failure, subsequent admission for atrial fibrillation or flutter, and subsequent ED electrocardioversion.

Of 1091 patients enrolled (mean age, 64 years), 85% had atrial fibrillation and 15% had flutter. Electrical or pharmacologic cardioversion was used in 73% of patients, 9% were admitted, and 80% converted to sinus rhy…