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Stroke Risk Handouts

CHADS-VASc=2

CHADS-VASc=3

CHADS-VASc=4

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

HAS-BLED Score

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.