Management of patients with acute atrial fibrillation in the ED.
BACKGROUND
Patients with acute atrial fibrillation with a history of mild structural heart disease could be considered for rhythm conversion.


METHODS
Patients received intravenous flecainide, propafenone, or amiodarone on presentation and a second dose after 6 hours if atrial fibrillation persisted. No randomization was used, and drugs were given at the discretion of the treating physician. Primary end point was rhythm conversion within the first 6 hours from presentation. Secondary end points included rhythm conversion, time to rhythm conversion, and adverse drug effects within 24 hours.


RESULTS
Among the 378 patients enrolled, 37 (10%) recovered sinus rhythm before therapy was given. Of the remaining 341 patients, 43 (13%) received flecainide, 187 (55%) received propafenone, and 111 (32%) received amiodarone. Baseline clinical characteristics were homogeneous among groups. Rhythm conversion was obtained in 87% of treated patients overall. Within 6 hours, the primary end point was achieved in a higher proportion in the flecainide and propafenone groups (72% and 55%, respectively) as compared with the amiodarone group (30%; P < .001). The mean time to the end point overall was shorter in the flecainide and propafenone groups (178 ± 227 and 292 ± 285 minutes, respectively) as compared with the amiodarone group (472 ± 269 minutes; P < .001). Length of in-hospital stay in the amiodarone group was significantly higher (26.1 ± 22.4 hours) compared with the flecainide and propafenone groups (8.9 ± 10.3 and 11.0 ± 13.8 hours; respectively; P = .001). No significant differences were found in adverse drug effects.


CONCLUSIONS
Flecainide and propafenone achieve rhythm control in a higher proportion of patients as compared with amiodarone within a 6-hour management.
Conti
Alberto
A
Emergency Medicine and Chest Pain Unit, Careggi University Hospital, 50121 Florence, Italy. aaaconti@hotmail.com
Del Taglia
Beatrice
B
Mariannini
Yuri
Y
Pepe
Giuseppe
G
Vanni
Simone
S
Grifoni
Stefano
S
Abbate
Rosanna
R
Michelucci
Antonio
A
Padeletti
Luigi
L
Gensini
Gian Franco
GF
D000208:Acute Disease; D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004554:Electric Countershock; D004636:Emergency Service, Hospital; D005260:Female; D005424:Flecainide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay; D008297:Male; D011405:Propafenone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D011405:Propafenone; D005424:Flecainide; D000638:Amiodarone