Acute Cardioversion Versus Wait And See-approach for Symptomatic Atrial Fibrillation in the Emergency Department

Conditions

Atrial Fibrillation

Keywords

Atrial fibrillation, Electrical cardioversion, Pharmacological cardioversion, Rhythm control, Rate control

Brief summary

A symptomatic episode of the heart rhythm disorder 'atrial fibrillation' (AF) is a frequent reason for visits to the emergency department. Currently, in the majority of cases, immediate (electrical or pharmacological) cardioversion is chosen, while atrial fibrillation terminates spontaneously in 70% of the cases within 24 hours. A wait-and-see approach with rate-control medication only, and when needed cardioversion within 48 hours of onset of symptoms, could be effective, safe and more cost-effective than current standard of care and could lead to a higher quality of life.

Rachel M J van der Velden, Nikki A H A Pluymaekers, Elton Dudink, Justin Luermans, Joan G. Meeder et al. (19 authors)

Heart2022-08-298 citations

10.1136/heartjnl-2022-321346

Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation

Nikki A H A Pluymaekers, Elton Dudink, Justin Luermans, Joan G. Meeder, Timo Lenderink et al. (21 authors)

New England Journal of Medicine2019-03-18196 citations

10.1056/nejmoa1900353

Acute cardioversion vs a wait-and-see approach for recent-onset symptomatic atrial fibrillation in the emergency department: Rationale and design of the randomized ACWAS trial.

Dudink E, Essers B, Holvoet W, Weijs B, Luermans J, Ramanna H, Liem A, van Opstal J, Dekker L, van Dijk V, Lenderink T, Kamp O, Kulker L, Rienstra M, Kietselaer B, Alings M, Widdershoven J, Meeder J, Prins M, van Gelder I, Crijns H.

2016-10-0211 citations

10.1016/j.ahj.2016.09.009

Interventions

DRUGPharmacological cardioversion - Flecainide

PROCEDUREElectrical cardioversion

DRUGMetoprolol

DRUGVerapamil

DRUGDigoxin

DRUGPharmacological cardioversion - Amiodarone

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

* ECG with atrial fibrillation at the emergency department * Heart rate \> 70bpm * Symptoms most probable due to atrial fibrillation * Duration of symptoms \< 36 hours * \> 18 years of age * Able and willing to sign informed consent * Able and willing to use MyDiagnostick

Exclusion criteria

* Signs of myocardial infarction on ECG * Hemodynamic instability (systolic blood pressure \< 100mm Hg, heart rate \> 170 bpm) * Presence of pre-excitation syndrome * History of Sick Sinus Syndrome * History of unexplained syncope * History of persistent AF (episode of AF lasting more than 48 hours) * Acute heart failure * Currently enrolled in another clinical trial * Deemed unsuitable for participation by attending physician

Design outcomes

Primary

Measure	Time frame	Description
12-lead ECG	4 weeks	Presence of sinus rhythm on ECG

Secondary

Measure	Time frame	Description
Time to conversion to sinus rhythm (Holter monitor)	48 hours	Intervention group only
Quality of life (SF-36)	Baseline, 4 weeks, 6 months, 12 months	—
Quality of Life (AFEQT)	Baseline, 4 weeks, 6 months, 12 months	—
Time to first recurrence of Atrial Fibrillation	1 month	Monitoring through handheld device
Total health care and societal costs	1 year	—
One-year follow-up of Major Adverse Cerebrovascular or Cardiovascular Events	One year	—

Countries

Netherlands

Outcome results

None listed