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Emergency management of atrial fibrillation

¹ Department of Emergency Medicine, Beaumont Hospital, Dublin, Republic of Ireland
² Department of Medicine, Our Lady’s Hospital, Navan, Republic of Ireland

Correspondence to:
Correspondence to:
Mr A Wakai, Department of Emergency Medicine, Beaumont Hospital, Beaumont Road, Dublin 9, Republic of Ireland;
wakai{at}indigo.ie

Atrial fibrillation is the most common cardiac arrhythmia managed by emergency and acute general physicians. There is increasing evidence that selected patients with acute atrial fibrillation can be safely managed in the emergency department without the need for hospital admission. Meanwhile, there is significant variation in the current emergency management of acute atrial fibrillation. This review discusses evidence based emergency management of atrial fibrillation. The principles of emergency management of acute atrial fibrillation and the subset of patients who may not need hospital admission are reviewed. Finally, the need for evidence based guidelines before emergency department based clinical pathways for the management of acute atrial fibrillation becomes routine clinical practice is highlighted.

Keywords: atrial fibrillation; emergency department

Abbreviations: AFFIRM, Atrial Fibrillation Follow-up Investigation in Rhythm Management (trial); INR, international normalised ratio; RACE, Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation (trial); TDP, torsades de pointes; TOE, transoesophageal echocardiography