Society guidelineCanadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Management of Recent-Onset Atrial Fibrillation and Flutter in the Emergency Department
Section snippets
Evidence for Emergency Department Management
Variation in practice within Canadian EDs has been observed, and this variation likely reflects a lack of high-quality evidence to guide the acute management of recent-onset AF patients.18, 19 Standard guidelines and textbooks are unable to offer clear evidence-based direction for emergency physicians.1, 20 Particularly controversial is the issue of using rhythm control or rate control.1, 12, 13, 14 The very large AFFIRM and AF-CHF clinical trials compared rate and rhythm control but did not
Overall approach
The priorities for ED management of recent-onset AF/AFL (Fig. 1) include rapid assessment of potential hemodynamic instability, the identification and treatment of the underlying or precipitating cause, and a careful assessment of the patient's history with particular attention to the risk of thromboembolism. At this time, evidence equally supports a strategy of rate control or rhythm control for stable patients with known onset of AF/AFL within 48 hours. Both approaches are presented here. The
Conclusion
Physicians frequently encounter ED patients with recent-onset AF/AFL and may safely manage these patients with either a rate-control or rhythm-control strategy. Immediate specialist consultation or admission to hospital is not often necessary. Careful consideration of the risks of thromboembolism is a priority and appropriate follow-up is important. There is a need for more evidence to specifically guide the unique management of patients in the ED with recent-onset AF.
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Cited by (110)
Emergency medicine (EM) can safely manage geriatric trauma patients sustaining ground level falls: Fostering EM autonomy while safely offloading a busy trauma service
2022, American Journal of SurgeryCitation Excerpt :One possible explanation for this is the lower ISS and rates of certain comorbidities such as CAD in the POST cohort, however this seems unlikely to fully explain this substantial difference in admission rates. Another possible explanation is an increased comfort by EM providers in the management of various medical comorbidities including atrial fibrillation25,26 and syncope.27 Another explanation is there has been an increased trend toward outpatient management of many traumatic injuries, which is an inherent limitation to this type of PRE/POST study design.
Can I Send This Patient With Atrial Fibrillation Home From the Emergency Department?
2022, Journal of Emergency MedicineAdverse Events Associated With Electrical Cardioversion in Patients With Acute Atrial Fibrillation and Atrial Flutter
2021, Canadian Journal of CardiologyRAFF-3 Trial: A Stepped-Wedge Cluster Randomised Trial to Improve Care of Acute Atrial Fibrillation and Flutter in the Emergency Department
2021, Canadian Journal of CardiologyAdverse Events Among Emergency Department Patients With Cardiovascular Conditions: A Multicenter Study
2021, Annals of Emergency Medicine
The disclosure information of the authors and reviewers is available from the CCS on the following websites: www.ccs.ca and www.ccsguidelineprograms.ca.
This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgment in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.
- c
For a complete listing of committee members, see Gillis AM, Skanes AC. Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Implementing GRADE and achieving consensus. Can J Cardiol 2011;27:27-30