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• W3088909853 abstract "Ian Stiell and colleagues1Stiell IG Sivilotti MLA Taljaard M et al.Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomised trial.Lancet. 2020; 395: 339-349Summary Full Text Full Text PDF PubMed Scopus (39) Google Scholar hypothesised that procainamide with eventual direct-current (DC) shock would be superior to immediate DC shock in patients with recent-onset atrial fibrillation at the emergency department, but this could not be proven in their study. By contrast, procainamide could enhance cardioversion in persistent atrial fibrillation, which is more resilient to DC shock than recent-onset paroxysmal atrial fibrillation.2Van Noord T Van Gelder IC Crijns HJ How to enhance acute outcome of electrical cardioversion by drug therapy: importance of immediate reinitiation of atrial fibrillation.J Cardiovasc Electrophysiol. 2002; 13: 822-825Crossref PubMed Scopus (21) Google Scholar Likewise, the high effectiveness of DC shock in recent-onset atrial fibrillation precluded finding a difference between paddle positions, which is in contrasts with results of a previous study in persistent atrial fibrillation.3Kirchhof P Eckardt L Loh P et al.Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial.Lancet. 2002; 360: 1275-1279Summary Full Text Full Text PDF PubMed Scopus (180) Google Scholar The authors argue that, compared with our delayed cardioversion approach,4Pluymaekers NAHA Dudink EAMP Luermans JGLM et al.Early or delayed cardioversion in recent-onset atrial fibrillation.N Engl J Med. 2019; 380: 1499-1508Crossref PubMed Scopus (95) Google Scholar acute intervention is less burdensome for patients and the hospital because return visits are not needed. However, our strategy was associated with less cardioversions (30% vs virtually all patients), far fewer complications (1% vs 20%), and all-in-all less time spent in the emergency department (2 h vs 7 h). The fact that hospitals cannot offer 24/7 cardioversion services, as the authors maintain, forms an argument in favour of initial rate control with eventual delayed cardioversion, since it turns disruptive acute care into more efficient planned care, and it also relieves patients who report outside of office hours. All these reasons suggest a lower burden to patients and hospitals. An important drawback of acute intervention is that it precludes many patients experiencing that their arrhythmia might terminate by itself, which could enhance their confidence, reduce anxiety, and stimulate self-management. Acute treatments might distract physicians' attention from atrial fibrillation requiring assessment of stroke risk, and treatment of underlying cardiovascular diseases and risk factors contributing to atrial fibrillation.5Middeldorp ME Ariyaratnam J Lau D Sanders P Lifestyle modifications for treatment of atrial fibrillation.Heart. 2020; 106: 325-332Crossref PubMed Scopus (55) Google Scholar HJGMC reports grants from Netherlands Cardiovascular Research Initiative (an initiative with support of the Dutch Heart Foundation) and CVON 2014-9 (reappraisal of atrial fibrillation: interaction between hypercoagulability, electrical remodeling, and vascular destabilisation in the progression of atrial fibrillation [RACE V]), unrelated to this Correspondence. All other authors declare no competing interests. Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomised trialBoth the drug–shock and shock-only strategies were highly effective, rapid, and safe in restoring sinus rhythm for patients in the emergency department with acute atrial fibrillation, avoiding the need for return to hospital. The drug infusion worked for about half of patients and avoided the resource intensive procedural sedation required for electrical cardioversion. We also found no significant difference between the anterolateral and anteroposterior pad positions for electrical cardioversion. Full-Text PDF Emergency department cardioversion of acute atrial fibrillationWe applaud Ian Stiell and colleagues1 for their well designed and executed trial comparing two common methods of cardioversion for stable emergency department patients with acute atrial fibrillation. Their efficacy and safety results will better inform the shared decision-making conversations we undertake with our emergency department patients eligible for elective cardioversion. Full-Text PDF Emergency department cardioversion of acute atrial fibrillationI read with great interest the Article by Ian Stiell and colleagues.1 The findings of this well designed trial will add substantially to the literature on the topic of cardioversion for patients with acute atrial fibrillation presenting to an emergency department. Full-Text PDF Emergency department cardioversion of acute atrial fibrillation — Authors' replyWe thank Nikki Pluymaekers and colleagues, David Vinson and colleagues, and Ian DeSouza for their thoughtful comments on the results of the RAFF2 study.1 Full-Text PDF" @default.
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• W3088909853 title "Emergency department cardioversion of acute atrial fibrillation" @default.
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• W3088909853 doi "https://doi.org/10.1016/s0140-6736(20)31311-8" @default.
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