Comparison of different tactics for atrial fibrillation treatment in the emergency medical center stage

To find out what approaches are used for acute onset atrial fibrillation [AF] in ED and to compare their efficiency. The study summarizes data on 468 AF patients  hospitalized in the Emergency Medicine Center of P. Stradins Clinical University Hospital in the period from July 1, 2020 to September 21, 2020. Of these, 181 patients who underwent cardioversion at the ED stage were selected and analyzed. The primary endpoints were conversion to sinus rhythm (SR) after pharmacological (PC) and electrical cardioversion (ECV), as well as depending on the antiarrhythmic drugs (AAD) used. Secondary results were a comparison of time spent at the ED by type of cardioversion and AAD PC was used as the first-line tactic to restore sinus rhythm in 83% (n=123) of patients, and was successful in 76% (n=93) of cases. ECV was given to 17% (n=26) of patients, ensuring 100% (n=26) conversion to SR, including patients after unsuccessful PC (24,4%, n=30). To promote maintenance of SR after ECV, 62% (n=16) of patients were premedicated with amiodarone. Amiodarone was predominantly used during PK (88%, n=106), although more than half of the patients in the amiodarone group had no contraindications to propafenone, which was used in only 12% of cases. Sinus rhythm was restored to a statistically insignificantly higher proportion of patients in the propafenone group than in the amiodarone group (86% (n=12) vs. 75% (n=79), p=0,358). Analyzing the time spent in the ED, similar results were obtained in the propafenone and ECV groups (5.2 vs. 6.2 hours, p=0,528), while in the amiodarone group it was twice as high (10.7 hours, p=0,001).  ECV is more effective in restoring sinus rhythm than PC with intravenous amiodarone or propafenone. ECV and PC with intravenous propafenone restore sinus rhythm faster than PC with amiodarone, allowing patients to be discharged twice as fast.