Selecting rate control for recent-onset atrial fibrillation. Managing recent-onset atrial fibrillation in the emergency department. In this cohort of 660 patients, there were no thromboembolic events and the relapse rate was 8.6% at 7 days. The Ottawa Aggressive Protocol appears to be highly effective in converting patients with recent onset atrial fibrillation or flutter back to sinus rhythm. The study does not compare this protocol to standard care so we can’t comment on whether this protocol would reduce ED LOS, hospital admission or other endpoints in comparison to standard care. Implementation of the Ottawa Aggressive Protocol would be a reasonable approach for management of recent-onset AF. The authors’ conclusions regarding hospital admissions and expedited ED care are not supported by this study as there is no comparison group. Many patients have both conditions as one rhythm can. This may produce similar symptoms to atrial flutter because of how fast the heart beats. When the heart's chamber fibrillates, it quivers or shakes, rather than contracting. Based on this retrospective cohort study, use of the Ottawa Aggressive Protocol appears to be safe and effective. In contrast to atrial flutter, atrial fibrillation is a more chaotic rhythm that does not follow one set loop. “The Ottawa Aggressive Protocol is effective, safe and rapid and has the potential to significantly reduce hospital admissions and expedite ED care.” Our ConclusionsĪlthough this article is 5 years old, the issue of rhythm versus rate control continues to rage on. Of note, most studies lump AF and atrial flutter together as the management and disposition is typically the same. Additionally, the rate control supporters argue that patients’ history may be unreliable in establishing time of onset. However, some recent literature has called this classic teaching into question ( Nuotio 2014). It has long been taught that if the patient has been in AF for < 48 hours, the risk of developing a clot in the left atrium is negligible and cardioversion may be pursued. Thus, it should not be performed until the absence of clot in the left atrium is confirmed (by TEE) or appropriate anticoagulation has occurred. The rate control group argues that cardioversion runs the risk of causing a thromboembolic event (i.e.
The rhythm control supporters argue that AF is abnormal, worsens quality of life, leads to cardiac remodeling and, in may patients, requires medications for rate control and anticoagulation. This debate was showcased in a point-counterpoint in Annals of Emergency Medicine in 2011 ( Stiell 2011, Decker 2011). converted back to sinus rhythm) or rate controlled only. The debate centers on whether patients with recent-onset AF should be rhythm controlled (e.g. Why? Well, the management of these patients is potentially exciting, filled with procedures and clearly debatable. However, it’s the patients with new onset AF that really peak our interest. Patients with chronic AF often present with increased heart rates, chest pain and weakness among other presentations. We also are able to utilize the most advanced mapping systems.Atrial fibrillation (AF) is one of the most common dysrhythmias encountered in the ED. We are one of only a handful of centers in the United States that provide a complete suite of approaches to AFib, including hybrid procedures with epicardial robotic surgery in conjunction with endocardial ablation. Current research seeks to understand the mechanisms of atrial fibrillation, which appear to come from multiple areas at the same time.Īt the University of Chicago Medicine, our team uses special catheters that allow them to know how much force is being applied onto the tissue, which has been shown to improve the success rate for the procedure. We start with the initial set of treatments and then we get more aggressive as the pest problem declares itself to be more and more stubborn. Common symptoms of both conditions include palpitations, fatigue, chest pain, and blurry vision. Both of these diseases are serious and need medical treatment. Both of these conditions involve the heart's electrical activity, but they are not the same thing. We come in and we do a treatment and we can control the cases but frequently it requires multiple treatments. Atrial flutter and atrial fibrillation (AFib) are two types of atrial tachycardia. We give patients the analogy that atrial fibrillation is like a pest problem in your home. Similar to atrial flutter, treatment options for AFib include anticoagulation (blood thinners) and controlling the arrhythmia with medication or catheter ablation therapy.Īblation is also effective in 60% to 70% of AFib patients.
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