top of page

RISTRA AF Reference PDFs

RISTRA AF Executive Summary

Stroke Risk Handouts










Other PDF Links

Dabigatran Patient Handout 

DOACS Reference Guide

Master reference document 

Triggers of Paroxysmal AF

  • Vinson DR. Redressing the underrecognition of “Cold Drink Heart”: Patients teaching physicians about atrial fibrillation triggered by cold drink and food. Perm J. 2020;24:19.238.  pdf


  • Voskoboinik A, Marcus GM. The impact of alcohol intake on AF. Curr Cardiol Rep. 2020;22(10):111.  pdf


  • Voskoboinik A, et al. Caffeine and arrhythmias: time to grind the data. JACC Clin Electrophysiol. 2018;4(4):425-432.  pdf   (Coffee is not a trigger and may actually be protective)


Society AF Guidelines

  • January CT, et al. 2014 AHA/ACC/HRS Guideline for the management of pts c AF. J Amer Coll Cardiol. 2014;64(21):e1-76. pdf

    • Candidates for rhythm control strategy: section 6, p. e32

    • Stroke prevention in pts undergoing cardioversion: section 6.1.1, p. e33

    • Methods to improve success of DCCV: section 6.1, p. e34


  • January CT, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for AF. Circ. 2019;140:e125–e151.  pdf     Nothing new was added on cardioversion; see 2014 above.


  • Hindricks G, et al. 2020 ESC Guidelines for the diagnosis and management of AF. Eur Heart J.  2020 Aug 29 [online ahead of print].   pdf 

  • Andrade JG, et al. The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of AF. Can J Cardiol. 2020;36(12):1847-1948.   pdf


Sustained Rate Reduction

Early Oral Long-acting Rate-reducing Meds Facilitate Home Discharge

  • Zimetbaum P, et al. Impact of a practice guideline for pts with AF on medical resource utilization and costs. Am J Cardiol. 2003;92:677–681. pdf

  • De Leon E, et al. Impact of standardizing management of AF with rapid HR in the ED. Perm J. 2018;22:17-049. pdf


  • DeMeester S, et al. Implementation of a novel algorithm to decrease unnecessary hospitalizations in pts presenting to a community ED with AF. Acad Emerg Med. 2018;25(6):642-649. pdf

Adjunct IV MgSO4 Improves Sustained Rate Reduction

  • Bouida W, et al. Low-dose mag vs high dose in the early management of rapid AF: Randomized controlled double-blind study. Acad Emerg Med. 2019;26(2):183-191. pdf


  • Davey MJ, Teubner D. A randomized controlled trial of magnesium sulfate, in addition to usual care, for rate control in AF. Ann Emerg Med. 2005;45(4):347-53. pdf


Rate Reduction Reduces Effectiveness of Cardioversion

  • Blecher GE, et al. Rate control meds before ED cardioversion of recent-onset AF or flutter reduces success. CJEM. 2012;14(3):169-77. pdf


Sustained ED Rate Reduction and Effective Cardioversion Associated with Home Discharge in KPNC EDs

  • Le DD, et al. Wide variation in hospitalization of emergency department patients with AF and flutter in a U.S. integrated health care delivery system. Acad Emerg Med. 2018;25(S1):S42-43 [abstract 97]. pdf (Manuscript under peer review: Kea B, et al. Predictors of acute AFF hospitalization across 7 U.S. EDs)

Electrical Cardioversion

  • Stiell IG, et al. Electrical vs pharmacological cardioversion for ED pts w/ acute AF. Lancet. 2020;395:339-349. pdf


  • Scheuermeyer FX, et al. Chemical-first or electrical-first cardioversion strategy for uncomplicated acute AF. Acad Emerg Med. 2019;26(9):969-981. pdf


  • Ramirez FD, et al. The Ottawa AF Cardioversion Protocol. Europace. 2019;21(5):708-715. pdf


  • Vinson DR, et al. Improving first shock success in pts with AF undergoing electrical cardioversion. Europace. 2019;21(5):833. pdf


  • Voskoboinik A, et al. Cardioversion of AF in obese pts. J Cardiovasc Electrophysiol. 2019;30(2):155-161.   pdf


  • Vinson DR, et al. Managing ED patients with recent-onset AF. J Emerg Med. 2012;42(2):139-48. pdf


  • Vinson DR, et al. ED management of AFF and patient quality of life at one month postvisit. Ann Emerg Med. 2015;66(6):646-654. pdf


Pharmacologic Cardioversion

Procainamide Effectiveness and Safety in Canadian and KPNC EDs

  • Stiell IG, et al. Electrical vs pharmacological cardioversion for ED pts w/ acute AF. Lancet. 2020;395:339-349. pdf  


  • Vinson DR, et al. Emergency department cardioversion of acute AF. Lancet. 2020;396(10255):885.  pdf


  • Stiell I, et al. Canadian Assn of Emerg Physicians AFF Best Practices Checklist. CJEM. 2018;20(3):334-342. pdf


  • Stiell IG, et al. Association of the Ottawa Aggressive Protocol with rapid discharge of ED pts with recent-onset AF or flutter. CJEM. 2010;12(3):181-91. pdf


  • Lugovskaya N, et al. Effectiveness and safety of procainamide in the cardioversion of AFF [abstract]. Ann Emerg Med. 2016;68(4S):S40. pdf


  • Vinson DR, et al. Procainamide vs ibutilide in the cardioversion of recent-onset AFF [abstract]. Ann Emerg Med. 2019;74(4S):S7-8. pdf


Ibutilide in KPNC EDs

  • Vinson DR, et al. Ibutilide effectiveness and safety in the cardioversion of AF and flutter in the community ED. Ann Emerg Med. 2018;71(1):96-108. pdf


  • Le DD, et al. ECG diagnosis: ibutilide-induced torsade de pointes. Perm J. 2019;23:18-187. pdf


Amiodarone in KPNC EDs

  • Nagam MR, et al. Patient selection, dosing patterns, safety, and delayed time to effect of IV amiodarone in the cardioversion of AF and flutter in 13 U.S. community EDs [abstract]. Acad Emerg Med. 2018;25(S1):S224. pdf


Oral Flecanide and Propafenone

  • Alboni P, et al. Outpatient treatment of recent-onset AF with the "pill-in-the-pocket" approach. N Engl J Med. 2004;351(23):2384-91.  pdf


Systematic Review (limited to trial data, thereby underrepresenting procainamide)

  • deSouza IS, et al. Pharmacologic cardioversion of recent-onset AF and Flutter in the ED: A systematic review and network meta-analysis. Ann Emerg Med. 2020;76(1):14-30.  pdf


The Timing Debate re: Cardioversion: Today or Tomorrow?

  • Pluymaekers NA, et al. Early or delayed cardioversion in recent-onset AF. N Engl J Med. 2019;380(16):1499-1508. pdf


  • Vinson DR, Atzema CL. Response to Pluymaekers. N Engl J Med. 2019;381(4):386-387. pdf


  • Boriani G, et al. Managing AF: editorial on Pluymaekers. Intern Emerg Med. 2020;15(1):9-12. pdf


  • Botto GL, et al. Is delayed cardioversion better? Yes. Intern Emerg Med. 2020;15(1):1-4. pdf


  • Capucci A, et al. Is delayed cardioversion better? No. Intern Emerg Med. 2020;15(1):5-7. pdf


  • Vinson DR, et al. Managing ED patients with recent-onset AF. J Emerg Med. 2012;42(2):139-48. pdf


  • Nuotio I, et al. Time to cardioversion for acute AF and thromboembolic complications. JAMA. 2014;312(6):647-9. pdf

  • Pluymaekers NA, et al. Frequency and determinants of spontaneous conversion to sinus rhythm in patients presenting to the emergency department with recent-onset atrial fibrillation: A systematic review. Arrhythm Electrophysiol Rev. 2020;9(4):195-201. pdf


  • Pluymaekers, N.A.H.A., Dudink, E.A.M.P., Weijs, B. et al. Clinical determinants of early spontaneous conversion to sinus rhythm in patients with atrial fibrillation. Neth Heart J. 2021. pdf

Anticoagulation after ED Cardioversion

  • Lip G, et al. Antithrombotic therapy for AF: CHEST Guideline and Expert Panel Report. Chest. 2018;154(5):1121-1201.  pdf


  • Andrade JG, et al. Periprocedural anticoagulation for cardioversion of acute onset AFF: evidence base for current guidelines. Can J Cardiol. 2019;35(10):1301-1310. pdf



  • Lip GY, Lane DA. Bleeding risk assessment in atrial fibrillation: observations on the use and misuse of bleeding risk scores. J Thromb Haemost. 2016;14(9):1711-4.  pdf


  • Pisters R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093-100.   pdf

The Long-term Benefits of an Early Rhythm-control Strategy in Select Pts

  • Kirchhof P, et al; EAST-AFNET 4 Trial Investigators. Early Rhythm-control therapy in patients with atrial fibrillation. N Engl J Med. 2020;383:1305-1316. pdf  Using catheter ablation (19%) and antiarrhythmic drugs in patients beginning within their first year of AF diagnosis.

bottom of page