Atrial fibrillation (AF) and atrial flutter (AFL) are cardiac rhythm problems where the upper heart chambers beat in a disorganized fashion leading to an irregular rapid heart rate. AF is the most common heart rhythm problem seen by doctors. In the emergency department (ED), doctors often manage patients with either recent-onset or long-term AF. Our project focuses on patients with recent-onset episodes of AF or AFL (RAFF) where the onset is less than 48 hours. RAFF is the most common rhythm disorder managed in the ED. There is disagreement amongst doctors for two different and competing treatment approaches. The first is called conservative treatment and consists of slowing the heart rate with drugs, preventing stroke with blood thinners, sending the patient home with ongoing AF/AFL, and possibly providing an electric shock 4 weeks later. The second approach is called aggressive treatment where doctors put the patient’s heart rhythm back to a regular rhythm with either drugs or electrical shock in the ED. We have completed two studies to prepare for this project. The first was a patient records review of 1,068 RAFF patients at 8 Canadian EDs. The second was an on-line survey of 506 Canadian ED doctors. Both showed a great deal of variation in treatment practices. This means that doctors used a variety of treatment approaches. This suggests a need for better research to help doctors choose the best way to treat patients.

Principal Investigator: Dr. Ian Stiell
Co-Investigators: Dr. Jeff Perry, Dr. George Wells, Dr. Bjug Borgundvaag, Dr. Robert Brison, Dr. Brian Rowe, Dr. Trevor Langhan, Dr. Kirk Magee, Dr. Rob Stenstrom
Funding Agency: Heart and Stroke Foundation of Ontario
Duration of Study: June 2010 – June 2013

For additional information, please contact Cathy Clement, Program Manager.