The articles were grouped into four main categories : decision aids and outcome predictors , electrical cardioversion-based protocol s , antiarrhythmic-based protocol s , and general management protocol s. Conclusion This systematic review is the first study to our knowledge to evaluate the optimal management of symptomatic AF/AFLin  the ED with a direct impact on ED disposition .
There are several viable management strategies that can result in safe discharge from the ED in the right patient population , and decision aids can be utilized to guide selection of appropriate patients for discharge
Introduction Management of  atrial fibrillation ( AF ) and atrial flutter ( AFL )  in the emergency department ( ED ) varies greatly , and there are currently no United States guidelines to guide management with regard to patient disposition after ED treatment .
The aim of this systematic review was to evaluate the literature for decision aids to guide disposition of patients with AF/AFLin the ED , and assess potential outcomes associated with different management strategies in the ED .
Effectiveness of verapamil-quinidine versus digoxin-quinidine in the emergency department treatment of paroxysmal atrial fibrillation.
STUDY OBJECTIVE To determine the relative effectiveness of a verapamil-quinidine sequential combination versus digoxin-quinidine in the emergency department treatment of paroxysmal atrial fibrillation ( PAF ) . METHOD This prospect i ve , double-blind , r and omized , controlled trial involved patients , aged 18 to 75 years , with new-onset ( < 48 hours ) atrial fibrillation who presented to a community-based urban hospital with an annual ED census of 65,000 . Exclusion criteria included ventricular response rate lower than 100 or higher than 200 beats/minute , allergy to study drugs , hypotension with evidence of end-organ hypoperfusion , and conduction abnormalities . Consenting patients were r and omly assigned to receive rapid digitalization ( 1.0 mg over 2 hours ) or i.v . verapamil ( sequential 5-mg boluses up to 20 mg ) . After ventricular rate was controlled ( < 100 beats/minute ) , oral quinidine ( 200 mg ) was initiated and repeated every 2 hours until conversion to normal sinus rhythm ( NSR ) occurred , until 1 g of quinidine was administered , or until adverse effects supervened . Heart rate , blood pressure , cardiac rhythm , time to conversion , and adverse effects were documented . RESULTS Forty-four patients received the study drugs . Three were withdrawn , leaving 19 in the verapamil-quinidine ( VER-Q ) group and 22 in the digoxin-quinidine ( DIG-Q ) group . Sixteen patients ( 84 % ) in the VER-Q group and 10 ( 45 % ) in the DIG-Q group converted to NSR within 6 hours ( P < .02 ) . Mean time to conversion ( + /-SD ) was 185 + /- 146 minutes for VER-Q and 368 + /- 386 minutes for DIG-Q patients ( P = NS ) . Twelve VER-Q patients ( 63 % ) and 6 DIG-Q patients ( 27 % ) were discharged from the ED ( P < .05 ) . Minor adverse effects were more common in the VER-Q group . No mortality or significant morbidity occurred . CONCLUSION The sequential combination of verapamil and quinidine , in the doses studied , is an effective treatment for PAF and is superior to digoxin-quinidine . Digoxin should no longer be considered the treatment of choice for uncomplicated PAF
The articles were grouped into four main categories : decision aids and outcome predictors , electrical cardioversion-based protocol s , antiarrhythmic-based protocol s , and general management protocol s. Conclusion This systematic review is the first study to our knowledge to evaluate the optimal management of symptomatic AF/AFLin  the ED with a direct impact on ED disposition .
There are several viable management strategies that can result in safe discharge from the ED in the right patient population , and decision aids can be utilized to guide selection of appropriate patients for discharge
Introduction Management of  atrial fibrillation ( AF ) and atrial flutter ( AFL )  in the emergency department ( ED ) varies greatly , and there are currently no United States guidelines to guide management with regard to patient disposition after ED treatment .
The aim of this systematic review was to evaluate the literature for decision aids to guide disposition of patients with AF/AFLin the ED , and assess potential outcomes associated with different management strategies in the ED .