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Thursday, February 10, 2022

Atrial Fibrillation/Flutter

EM Ottawa - By Pascale King, Amanda Mattice - February 10, 2022 
Atrial fibrillation (AF) is encountered with significant frequency in the Emergency Department (ED). In fact, atrial fibrillation is the single most common arrhythmia seen in the ED. As per the 2020 CCS review, AF resulted in 8815 same-day procedures, 76 964 ED visits, 25 892 acute care admissions in Canada in a given year.1 The CAEP 2021 guidelines were created in consensus with academic, community ED physicians and cardiologists from multiple sites across Canada. This post will review the literature leading to the new best practice guidelines and highlight major updates since the last management guidelines were posted in 2018 while identifying sources of practice variation.
This blog post will review the following and apply guidelines to common cases seen below:
  • New safe rhythm control timelines
  • Rate control and pitfalls
  • Stroke prevention
TAKE HOME POINTS
  • Refrain from aggressive treatment of secondary AF / AFL
  • Consider WPW in rapid HR for varying management
  • Rate control CHADS-65 positive ( >2 pts) patients at > 12 hrs if no anticoagulation on board
  • Calcium channel blockers and beta blockers are contraindicated in acute heart failure patients
  • Consider anticoagulation x 4 weeks in CHADS-65 negative patients after rhythm control