- In this trial comparing 2 rhythm control methods for emergency department (ED) patients with acute, short-duration Afib, both chemical and electrical rhythm control were effective, but the latter was faster.
Why this matters
- Both chemical-first and electrical-first strategies are considered safe, but few studies address their comparative effectiveness.
- All patients but 1 successfully cardioverted; all were discharged home.
- Chemical- vs electrical-first group:
- Proportion discharged within 4 hours: 32% (13/41) vs 67% (29/43) (95% CI, 16%-56%; P<.001>
- Median ED length of stay: 5.1 vs 3.5 hours; difference, 1.2 hours (95% CI, 0.4-2.0 hours; P<.001>
- Median time from randomisation to conversion: 2.3 vs 0.6 hours; difference, 1.4 (95% CI, 0.8-1.9) hours.
- 6-centre randomised study (n=84).
- Adults aged ≤75 years presenting to ED with low-risk, uncomplicated, symptomatic Afib of
- All had CHADS2 score of ≤1.
- Outcome: proportion discharged within 4 hours of arrival.
- Funding: None.
- May not generalise to older, sicker, or chronic Afib populations.
- ED lengths of stay likely influenced by multiple unrelated factors.
- Over one-third of patients declined to enroll, potentially skewing population toward patients with new Afib.