EM Nerd - March 20, 2019 - By Rory Spiegel
..."Atrial fibrillation is a chronic disease with outcomes measured in years. Constraining its irregularities for the fleeting moments the patient is before us in the Emergency Department has minimal effect on patient outcomes or wellbeing. An immediate cardioversion strategy is a quixotic attempt to check a symptom that is not only incredibly difficult to control, but whose regulation has never been found to improve patient important outcomes. When viewed from this perspective, the futility of ED cardioversion seems obvious. It serves only as a distractor, diverting our attention from rate control and the appropriate use of anticoagulants, interventions that have proven benefits on patients’ downstream health and wellbeing."