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Emergency department (ED) management of atrial fibrillation and atrial flutter is typically directed at either rate control (medication followed by anticoagulation and delayed outpatient cardioversion) or rhythm control (electrical or pharmacologic cardioversion in the ED followed by discharge); no strong evidence supports one strategy over the other. To assess variation in ED management of these dysrhythmias, researchers conducted a retrospective cross-sectional study of 1068 patients with recent-onset atrial fibrillation (88%) or atrial flutter (12%) who presented to one of eight academic EDs in Canada during 2008. All patients were clinically eligible for either strategy.
The eight EDs varied substantially in treatments used, including in…