Grant: Operating Grant

Atrial fibrillation (AF) is a cardiac rhythm problem where the patient has a rapid and irregular heart beat. We plan to study Emergency Department (ED) patients with recent-onset episodes of AF (RAF) where rapid heart rate requires urgent treatment to restore normal heart rhythm. RAF is the most common rhythm disorder managed in the ED. We recently showed that doctors use a wide variety of treatment approaches in Canadian EDs for RAF. Also, the Canadian Cardiovascular Society Guidelines indicate that there have been no studies to know if the best treatment is to use an electrical shock (Shock Only) or drugs followed by shock (Drug-Shock). We believe that the Drug-Shock approach will be more effective and will help avoid an electric shock for many patients. We intend to conduct a randomized study in order to answer this question: Will initial drug treatment followed by electrical shock if necessary (Drug-Shock) lead to more patients being converted to normal heart rhythm than a strategy of only electrical shock (Shock Only)? We plan to enroll 396 RAF patients at 8 large Canadian EDs. Patients will be randomized to 1of 2 arms for the protocol. Our primary outcome will be conversion to normal heart rhythm. Other outcomes will include heart rhythm at discharge, need for hospital admission, length of stay in ED, adverse events, patient satisfaction, and 14-day follow-up status. Our results will add important information about the best and safest ways to treat RAF patients in Canadian EDs. Ultimately we expect to see fewer patients admitted to hospital and more patients rapidly and safely returned to their normal activities.