Abstract
BackgroundAtrial fibrillation (AF) is a common arrhythmia that causes numerous visits to emergency departments (ED). The aim of the FinFib2 study was to evaluate whether treatment of patients with AF in ED is consistent with the contemporary European Society of Cardiology (ESC) management guidelines. Here we report the results of antiarrhythmic drug therapy (AAD) in ED.MethodsAll patients within the two-week study period whose primary reason for the ED visit was symptomatic AF were included into this prospective multicentre study. Comprehensive data on factors contributing to the treatment of AF were collected, including a data of previous use of ADDs, and changes made for them during a visit in ED.ResultsThe study population consisted of 1013 consecutive patients (mean age 70 ± 13 years, 47.6% female). The mean European Heart Rhythm Association (EHRA) symptom score was 2.2 ± 0.8. Rhythm control strategy was opt for 498 (63.8%) and 140 (64.5%) patients with previously and newly diagnosed AF, respectively. In patients with previously diagnosed AF the most frequently used AAD was a beta blocker (80.9%). Prior use of class I (11.4%) and III (9.1%) AADs as well as start or adjustment of their dosage (7.4%) were uncommon. Most of the patients with newly diagnosed AF were prescribed a beta blocker (71.0%) or a calcium channel antagonist (24.0%), and only two of them received class I or class III AADs.ConclusionsOur data demonstrated that in patients presenting to the ED with recurrent symptomatic AF and aimed for rhythm control strategy, the use of class I and class III AADs was rare despite ESC guideline recommendations. It is possible that early adaptation of a more aggressive rhythm control strategy might improve a quality of life for symptomatic patients and alleviate the ED burden associated with AF. Beta blockers were used by majority of patients as rate control therapy both in rate and rhythm control groups.Trial registrationNCT01990105. Registered 15 November 2013.
Highlights
Atrial fibrillation (AF) is a common arrhythmia that causes numerous visits to emergency departments (ED)
We evaluated the use of antiarrhythmic drug therapy (AAD) therapy during an ED visit to support that decision; if the rhythm control was chosen, were a class I or III AAD started or a dosage of these drugs changed
We evaluated a use of rate control drugs for all patients, both in a rate and a rhythm control groups
Summary
Atrial fibrillation (AF) is a common arrhythmia that causes numerous visits to emergency departments (ED). In patients with acute AF the decision between rhythm and rate control is done in the ED. Presence of structural heart disease and other co-morbidities, the type of AF and contraindications to antiarrhythmic drugs (AAD) should be taken into account when evaluating the need and reasonability of cardioversion, and how to prevent recurrent AF episodes [8]. Rate control therapy should consider for all patients with AF if needed, both in a rate and a rhythm control strategies [10, 11]. Regardless of the chosen treatment strategy the need of oral anticoagulation (OAC) along with risk factors for thromboembolic complications and bleeding must be evaluated [10, 11]
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