A selection of resources
Atrial Fibrillation
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.
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.
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.