Grant: Project Grant

Atrial fibrillation (AF) is a cardiac rhythm problem where the patient has a rapid and irregular heartbeat. We plan to study emergency department (ED) patients with acute-onset episodes of AF where the rapid heart rate requires urgent treatment to restore normal heart rhythm. Acute AF is the most common rhythm disorder managed in the ED. Most Canadian ED physicians treat these patients with electrical shock or drugs but the most used drug, IV procainamide, is slow and not very effective. A much newer drug, IV vernakalant, appears to be faster and more effective but is not commonly used in Canada. There never has been a head-to-head comparison of these two drugs. We are conducting a clinical trial (RAFF4) to compare the two drugs and confirm that vernakalant is superior and therefore has the potential to allow AF patients to be discharged much more rapidly from our extremely crowded EDs, where cardiac monitors are at a premium. We have been conducting the RAFF4 trial with CIHR funding that will soon expire, and we have found our efforts to enroll at 12 Canadian hospitals across Canada have been hampered by the pandemic. With additional funding we can complete the target enrolment of 360 patients within 18 months. To date we have enrolled 180 patients, 75% in Ottawa. The RAFF4 trial randomizes patients to receive either IV procainamide or vernakalant in an "open-label" design that allows the doctors and nurses to know which drug is being used and thus more closely follows real-life practice. Our primary outcome is conversion to normal heart rhythm. Other outcomes include length of stay in ED, adverse events, and 30-day follow-up status. If vernakalant proves to be more effective, faster, and safer than IV procainamide, this will give clinicians an important alternative for drug cardioversion of acute AF. The study results should lead to higher rhythm conversion rates and more rapid discharges from our crowded EDs and impact care worldwide.