Atrial Fibrillation

A selection of resources

Atrial Fibrillation

Rate or Rhythm control?

Which rate control agent?

How to cardiovert when needed

Atiral Fibrillation

The guidelines

The NICE guidelines are quiet brief and not particularly helpful for those used to dealing with AF. The European Society of Cardiology guidelines are much more detailed, but other than some useful guidelines on exactly how to cardiovert there isn't a lot of acute AF an emergency department setting.

The RCEM website has this local guideline from Bart's hospital. Obviously as local guideline it is not to be followed exactly, but good example of a logical evidence based approach. Interestingly, this guideline and ESC suggest HR <110 being the safe cut off for discharge.

Atrial Fibrillation

The FOAM Resources

Some of the finest free to access resources out there

St Emlyn's

Review of paper discussing if early cardioversion is beneficial or not

Emergency Medicine case

This Canadian website gives a through references run down of AF in the Emergency Department. If you read one article read this one.

Table of onset times

Handy table of time to action and peak effective of various beta-blockers.

Atrial Fibrillation

Some useful papers

An RCT into magnesium and rate control

A place for magnesium? Although not suggested by NICE this paper suggest it is helpful in rate control when used in addition to other agents.

This non-inferiority RCT on delay cardioversion

This paper suggested that if looking at medium term outcomes there is no harm in waiting.

This observation study on ACS and AF

This paper found 1.3% of patients had AF on admission who had a diagnosis of ACS (STEMI/NTSEMI). However it was only those who developed AF during inpatient stay who had worse outcomes.