Acute Cardioversion Versus Wait And See-approach for Symptomatic Atrial Fibrillation in the Emergency Department

Acute Cardioversion Versus Wait And See-approach for Symptomatic Atrial Fibrillation in the Emergency Department (RACE 7 ACWAS-trial)

A symptomatic episode of the heart rhythm disorder 'atrial fibrillation' (AF) is a frequent reason for visits to the emergency department. Currently, in the majority of cases, immediate (electrical or pharmacological) cardioversion is chosen, while atrial fibrillation terminates spontaneously in 70% of the cases within 24 hours. A wait-and-see approach with rate-control medication only, and when needed cardioversion within 48 hours of onset of symptoms, could be effective, safe and more cost-effective than current standard of care and could lead to a higher quality of life.

Inclusion Criteria:

• ECG with atrial fibrillation at the emergency department
• Heart rate > 70bpm
• Symptoms most probable due to atrial fibrillation
• Duration of symptoms < 36 hours
• > 18 years of age
• Able and willing to sign informed consent
• Able and willing to use MyDiagnostick

Exclusion Criteria:

• Signs of myocardial infarction on ECG
• Hemodynamic instability (systolic blood pressure < 100mm Hg, heart rate > 170 bpm)
• Presence of pre-excitation syndrome
• History of Sick Sinus Syndrome
• History of unexplained syncope
• History of persistent AF (episode of AF lasting more than 48 hours)
• Acute heart failure
• Currently enrolled in another clinical trial
• Deemed unsuitable for participation by attending physician