4.5 Review

Emergency medicine updates: Atrial fibrillation with rapid ventricular response

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Review Emergency Medicine

Management of atrial flutter and atrial fibrillation with rapid ventricular response in patients with acute decompensated heart failure: A systematic review

Joshua D. Niforatos et al.

Summary: There is a lack of high-level evidence regarding the effectiveness and safety of pharmacological and nonpharmacological management options for atrial fibrillation/atrial flutter with rapid ventricular response in patients with acute decompensated heart failure.

ACADEMIC EMERGENCY MEDICINE (2023)

Article Emergency Medicine

Impact of intravenous calcium with diltiazem for atrial fibrillation/flutter in the emergency department

Nicole Rossi et al.

Summary: This study aimed to evaluate the effect of early intravenous (IV) calcium on systolic blood pressure (SBP) when administered with IV diltiazem in subjects with atrial fibrillation (AF) or flutter (AFL) with rapid ventricular response (RVR) in the Emergency Department (ED). The results showed that the administration of IV calcium along with IV diltiazem did not significantly impact SBP and other clinical outcomes compared to diltiazem monotherapy.

AMERICAN JOURNAL OF EMERGENCY MEDICINE (2023)

Article Cardiac & Cardiovascular Systems

Predictive value of high-sensitivity troponin for significant coronary artery disease in new-onset atrial fibrillation with rapid ventricular response

Zaran A. A. Butt et al.

Summary: This study aimed to determine the predictive value of high-sensitivity troponin-T (HS-cTnT) for significant coronary artery disease (CAD) in patients with new-onset atrial fibrillation (AF) and rapid ventricular response. The results showed that HS-cTnT may serve as an effective screening biomarker to predict nonsignificant CAD in these patients, allowing for more targeted and rationalized ischemic testing.

CORONARY ARTERY DISEASE (2023)

Article Emergency Medicine

Intravenous diltiazem versus metoprolol for atrial fibrillation with rapid ventricular rate: A meta-analysis

Qingsu Lan et al.

Summary: The meta-analysis results indicate that intravenous diltiazem has higher efficacy and shorter average onset time compared to intravenous metoprolol, with lower impact on ventricular rate and blood pressure. There is no significant difference in adverse events between the two drugs.

AMERICAN JOURNAL OF EMERGENCY MEDICINE (2022)

Review Cardiac & Cardiovascular Systems

High-Sensitivity Troponin T For The Risk Assessment Of Patients With Acute Atrial Fibrillation

Marcia Cortes et al.

Summary: This study found that elevations of high-sensitivity troponin T (Hs-TnT) are frequently observed in patients with acute atrial fibrillation, and these elevations are strongly associated with major adverse cardiovascular events (MACE) at 1-year, but not with atrial fibrillation reversion or recurrence.

CURRENT PROBLEMS IN CARDIOLOGY (2022)

Article Emergency Medicine

Acute management of atrial fibrillation in congestive heart failure with reduced ejection fraction in the emergency department

Michael Hasbrouck et al.

Summary: This study compared the incidence of adverse effects in heart failure patients with atrial fibrillation and rapid ventricular response who were treated with intravenous diltiazem or metoprolol. While the overall adverse effects were similar, the diltiazem group had a significantly higher incidence of worsening heart failure symptoms.

AMERICAN JOURNAL OF EMERGENCY MEDICINE (2022)

Article Medicine, General & Internal

Apixaban Versus Rivaroxaban in Patients With Atrial Fibrillation and Valvular Heart Disease A Population-Based Study

Ghadeer K. Dawwas et al.

Summary: In patients with atrial fibrillation and valvular heart disease, those receiving apixaban had a lower risk of ischemic stroke or systemic embolism and bleeding compared to those receiving rivaroxaban, according to this study.

ANNALS OF INTERNAL MEDICINE (2022)

Article Medicine, General & Internal

Comparative Effectiveness and Safety Between Apixaban, Dabigatran, Edoxaban, and Rivaroxaban Among Patients With Atrial Fibrillation: A Multinational Population-Based Cohort Study

Wallis C. Y. Lau et al.

Summary: This study compared the use of all DOACs in a large multinational population and found that apixaban was associated with a lower risk of gastrointestinal bleeding compared to other DOACs. There were no significant differences in the rates of ischemic stroke, intracranial hemorrhage, and all-cause mortality. These findings were consistent in older patients and those with chronic kidney disease, who are often underrepresented in clinical trials.

ANNALS OF INTERNAL MEDICINE (2022)

Article Medicine, General & Internal

Early Rhythm Control Therapy for Atrial Fibrillation in Low-Risk Patients A Nationwide Propensity Score-Weighted Study

Daehoon Kim et al.

Summary: Through analysis of the nationwide claims database of the Korean National Health Insurance Service, it was found that early rhythm control was associated with lower risk of cardiovascular complications in atrial fibrillation patients, including those with low stroke risk. The beneficial association of early rhythm control with cardiovascular outcomes was consistent among low-risk patients regardless of trial eligibility.

ANNALS OF INTERNAL MEDICINE (2022)

Article Emergency Medicine

What is the Best Agent for Rate Control of Atrial Fibrillation With Rapid Ventricular Response?

Brit Long et al.

Summary: Diltiazem and metoprolol are both effective agents for rate control in patients with atrial fibrillation and rapid ventricular response. However, diltiazem may achieve rate control faster.

JOURNAL OF EMERGENCY MEDICINE (2022)

Article Emergency Medicine

Can I Send This Patient With Atrial Fibrillation Home From the Emergency Department?

Brit Long et al.

Summary: This study reviewed the literature on patients with atrial fibrillation (AF) and found that the REDAF, AFFORD, and AFTER scores have modest predictive discrimination in predicting adverse events.

JOURNAL OF EMERGENCY MEDICINE (2022)

Article Clinical Neurology

Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge

Giuseppe Lippi et al.

Summary: Atrial fibrillation is the most frequent cardiac arrhythmia and is increasing in incidence and prevalence worldwide, especially in countries with middle socio-demographic index. The condition poses a significant economic burden and public health challenge in the future.

INTERNATIONAL JOURNAL OF STROKE (2021)

Article Emergency Medicine

Heart rate outcomes with concomitant parenteral calcium channel blockers and beta blockers in rapid atrial fibrillation or flutter

Shuroug A. Alowais et al.

Summary: In patients with rapid atrial fibrillation or flutter receiving both intravenous calcium channel blocker and beta blocker, 46% achieved target heart rate control without bradycardia, while 3.7% developed bradycardia. Factors such as age, initial heart rate, time between medication administrations, oral medication addition, or IV magnesium administration did not affect target heart rate achievement.

AMERICAN JOURNAL OF EMERGENCY MEDICINE (2021)

Review Cardiac & Cardiovascular Systems

The 2020 ESC Guidelines on the Diagnosis and Management of Atrial Fibrillation

Agnieszka Kotalczyk et al.

ARRHYTHMIA & ELECTROPHYSIOLOGY REVIEW (2021)

Article Cardiac & Cardiovascular Systems

The absolute and relative changes in high-sensitivity cardiac troponin I are associated with the in-hospital mortality of patients with fulminant myocarditis

Chao Liu et al.

Summary: In patients with fulminant myocarditis, most survivors experienced a decline in hs-cTnI within 24 hours, while the absolute and relative changes in hs-cTnI within 24 and 48 hours were strong predictors of in-hospital mortality.

BMC CARDIOVASCULAR DISORDERS (2021)

Article Cardiac & Cardiovascular Systems

Anterior-Lateral Versus Anterior-Posterior Electrode Position for Cardioverting Atrial Fibrillation

Anders Sjorslev Schmidt et al.

Summary: The study found that anterior-lateral electrode positioning was more effective than anterior-posterior electrode positioning for cardioverting atrial fibrillation, with no significant differences in safety outcomes between the two positions.

CIRCULATION (2021)

Article Medicine, General & Internal

Association of Rivaroxaban vs Apixaban With Major Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation

Wayne A. Ray et al.

Summary: This cohort study found that in Medicare beneficiaries aged 65 or older with atrial fibrillation, treatment with rivaroxaban compared with apixaban was associated with a significantly increased risk of major ischemic or hemorrhagic events.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2021)

Article Cardiac & Cardiovascular Systems

Low risk patients with acute atrial fibrillation and elevated high-sensitivity troponin do not have increased incidence of pathological stress tests

Johan Thelin et al.

Summary: This study aimed to investigate whether AF/AFL patients with RVR and elevated hsTnT have an increased incidence of pathological stress tests. The results showed that none of the controls reached the primary endpoint, while only 2 out of 45 cases reached the endpoint, with only one having significant CAD.

SCANDINAVIAN CARDIOVASCULAR JOURNAL (2021)

Article Cardiac & Cardiovascular Systems

Adverse Events Associated With Electrical Cardioversion in Patients With Acute Atrial Fibrillation and Atrial Flutter

Ian G. Stiell et al.

Summary: This study evaluated the safety of electrical cardioversion for patients with acute atrial fibrillation or atrial flutter in the emergency department. While serious adverse events were rare, there were a concerning number of events following sedation that required intervention. Older age, coronary artery disease, and the use of fentanyl were associated with a higher risk of important adverse events.

CANADIAN JOURNAL OF CARDIOLOGY (2021)

Article Emergency Medicine

2021 CAEP Acute Atrial Fibrillation/Flutter Best Practices Checklist

Ian G. Stiell et al.

CANADIAN JOURNAL OF EMERGENCY MEDICINE (2021)

Article Emergency Medicine

Practice Gap in Atrial Fibrillation Oral Anticoagulation Prescribing at Emergency Department Home Discharge

Bory Kea et al.

WESTERN JOURNAL OF EMERGENCY MEDICINE (2020)

Article Medicine, General & Internal

Early Rhythm-Control Therapy in Patients with Atrial Fibrillation

Paulus Kirchhof et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

Article Medicine, General & Internal

Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation

Nikki A. H. A. Pluymaekers et al.

NEW ENGLAND JOURNAL OF MEDICINE (2019)

Review Cardiac & Cardiovascular Systems

Periprocedural Anticoagulation for Cardioversion of Acute Onset Atrial Fibrillation and Flutter: Evidence Base for Current Guidelines

Jason G. Andrade et al.

CANADIAN JOURNAL OF CARDIOLOGY (2019)

Review Cardiac & Cardiovascular Systems

Elevated serum cardiac troponin and mortality in acute pulmonary embolism: Systematic review and meta-analysis

Ayman El-Menyar et al.

RESPIRATORY MEDICINE (2019)

Article Medicine, General & Internal

Etiology of Minor Troponin Elevations in Patients with Atrial Fibrillation at Emergency Department-Tropo-AF Study

Samuli Jaakkola et al.

JOURNAL OF CLINICAL MEDICINE (2019)

Article Medicine, General & Internal

Prescribing of oral anticoagulants in the emergency department and subsequent long-term use by older adults with atrial fibrillation

Clare L. Atzema et al.

CANADIAN MEDICAL ASSOCIATION JOURNAL (2019)

Review Emergency Medicine

Emergency medicine considerations in atrial fibrillation

Brit Long et al.

AMERICAN JOURNAL OF EMERGENCY MEDICINE (2018)

Article Cardiac & Cardiovascular Systems

Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014

Guy Rozen et al.

JOURNAL OF THE AMERICAN HEART ASSOCIATION (2018)

Article Cardiac & Cardiovascular Systems

Emergency Department, Hospital Inpatient, and Mortality Burden of Atrial Fibrillation in the United States, 2006 to 2014

Sandra L. Jackson et al.

AMERICAN JOURNAL OF CARDIOLOGY (2017)

Article Cardiac & Cardiovascular Systems

Anticoagulation, CHA2DS2VASc Score, and Thromboembolic Risk of Cardioversion of Acute Atrial Fibrillation (from the FinCV Study)

Toni Gronberg et al.

AMERICAN JOURNAL OF CARDIOLOGY (2016)

Article Cardiac & Cardiovascular Systems

Atrial fibrillation patients with CHA2DS2-VASc > 1 benefit from oral anticoagulation prior to cardioversion

Sara Sjalander et al.

INTERNATIONAL JOURNAL OF CARDIOLOGY (2016)

Review Cardiac & Cardiovascular Systems

Atrial Fibrillation and Myocardial Infarction: A Systematic Review and Appraisal of Pathophysiologic Mechanisms

Francesco Violi et al.

JOURNAL OF THE AMERICAN HEART ASSOCIATION (2016)

Article Emergency Medicine

Role of masked coronary heart disease in patients with recent-onset atrial fibrillation and troponin elevations

Alberto Conti et al.

EUROPEAN JOURNAL OF EMERGENCY MEDICINE (2015)

Letter Medicine, General & Internal

Time to Cardioversion for Acute Atrial Fibrillation and Thromboembolic Complications

Ilpo Nuotio et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2014)

Article Emergency Medicine

A Population-Based Description of Atrial Fibrillation in the Emergency Department, 2002 to 2010

Clare L. Atzema et al.

ANNALS OF EMERGENCY MEDICINE (2013)

Review Cardiac & Cardiovascular Systems

Atrial fibrillation: Profile and burden of an evolving epidemic in the 21st century

Jocasta Ball et al.

INTERNATIONAL JOURNAL OF CARDIOLOGY (2013)

Article Cardiac & Cardiovascular Systems

Atrial fibrillation-induced cardiac troponin I release

Abdul Shokor Parwani et al.

INTERNATIONAL JOURNAL OF CARDIOLOGY (2013)

Article Cardiac & Cardiovascular Systems

Minor elevations in troponin I are associated with mortality and adverse cardiac events in patients with atrial fibrillation

Ewout J. van den Bos et al.

EUROPEAN HEART JOURNAL (2011)

Article Medicine, General & Internal

Effect of β blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study

Philip M. Short et al.

BMJ-BRITISH MEDICAL JOURNAL (2011)

Article Emergency Medicine

Troponin utilization in patients presenting with atrial fibrillation/flutter to the emergency department: retrospective chart review

Nazanin Meshkat et al.

INTERNATIONAL JOURNAL OF EMERGENCY MEDICINE (2011)

Article Medicine, General & Internal

β-Blockers May Reduce Mortality and Risk of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease

Frans H. Rutten et al.

ARCHIVES OF INTERNAL MEDICINE (2010)

Article Cardiac & Cardiovascular Systems

Prognostic value of troponins in acute pulmonary embolism - A meta-analysis

Cecilia Becattini et al.

CIRCULATION (2007)

Review Medicine, General & Internal

Elevated cardiac troponin measurements in critically ill patients

Wendy Lim et al.

ARCHIVES OF INTERNAL MEDICINE (2006)

Article Cardiac & Cardiovascular Systems

Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study

J Heeringa et al.

EUROPEAN HEART JOURNAL (2006)

Article Cardiac & Cardiovascular Systems

Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock

NJ Mehta et al.

INTERNATIONAL JOURNAL OF CARDIOLOGY (2004)

Article Cardiac & Cardiovascular Systems

Atrial fibrillation: classification, pathophysiology, mechanisms and drug treatment

V Markides et al.

Article Medicine, General & Internal

Validation of clinical classification schemes for predicting stroke - Results from the national registry of Atrial Fibrillation

BF Gage et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2001)

Article Medicine, General & Internal

Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation.

AL Klein et al.

NEW ENGLAND JOURNAL OF MEDICINE (2001)