Emergency Medicine Reports'LLSA Exam Study Guide 2022

A Multicenter Randomized Trial to Evaluate a Chemical-First or Electrical-First Cardioversion Strategy for Patients With Uncomplicated Acute Atrial Fibrillation Authors: Frank X. Scheuermeyer, MD, MHSc, Gary Andolfatto, MD, Jim Christenson, MD, Cristina Villa-Roel, PhD, and Brian Rowe, MD, MSc Reprinted with permission from: Scheuermeyer FX, Andolfatto G, Christenson J, et al. A multicenter randomized trial to evaluate a chemical-first or electrical-first cardioversion strategy for patients with uncomplicated acute atrial fibrillation. Acad Emerg Med 2019;26:969-981. © 2018 by the Society for Academic Emergency Medicine ABSTRACT Background: Emergency department (ED) patients with uncomplicated atrial fibrillation (AF) of less than 48 hours may be safely managed with rhythm control. Although both chemical-first and electrical-first strategies have been advocated, there are no comparative effectiveness data to guide clinicians. Methods: At six urban Canadian centers, ED patients ages 18 to 75 with uncomplicated symptomatic AF of less than 48 hours and CHADS2 score of 0 or 1 were randomized using concealed allocation in a 1:1 ratio to one of the following strategies: 1) chemical cardioversion with procainamide infusion, followed by electrical countershock if unsuccessful; or 2) electrical cardioversion, followed by procainamide infusion if unsuccessful. The primary outcome was the proportion of patients discharged within 4 hours of arrival. Secondary outcomes included ED From the Department of Emergency Medicine, St Paul’s Hospital and the University of British Columbia (FXS, JC), Vancouver, BC; the Department of Emergency Medicine, South Health Campus and the University of Calgary, Calgary (FXS), AB; the Department of Emergency Medicine, Lions Gate Hospital the University of British Columbia (GA), Vancouver, BC; and the Department of Emergency Medicine, University of Alberta Hospital and the University of Alberta (CVR, BR), Edmonton, AB, Canada. Received December 9, 2017; revision received October 5, 2018; accepted October 23, 2018. The authors have no relevant financial information or potential conflicts to disclose. Author contributions: FXS conceived and designed the study, with substantial assistance from GA, BR, and JC; FXS, GA, and BR conducted the trial at St Paul’s Hospital, Mount St. Joseph’s Hospital, and South Health Campus; GA conducted the trial at Lions Gate Hospital; BR conducted the trial at University of Alberta Hospital and Sturgeon Community Hospital; CVR provided statistical analysis; FXS drafted the manuscript, and all authors contributed to its revision. All authors had full access to all of the data including statistical reports and tables in the study and vouch for the accuracy and completeness of the presented data and fidelity of the report to the study protocol. This study was not funded. Dr. Villa-Roel is supported by the Canadian Institutes of Health Research (CIHR) through a graduate student award in partnership with the Knowledge Translation Branch (Ottawa, Ontario). Dr. Rowe is supported by CIHR through a Tier I Canada Research Chair in Evidence-based Emergency Medicine (Ottawa, Ontario). The Providence Health Care research ethics board approved the study (reference number H12- 0048), and this was approved at all sites via harmonized ethics review. Written informed consent was obtained from patients or a legal representative before enrollment. Anonymized data will be shared upon reasonable request. Supervising Editor: Anna Marie Chang, MD. Address for correspondence and reprints: Frank Xavier Scheuermeyer; e-mail: ermeyer@ . ACADEMIC EMERGENCY MEDICINE 2019;26:969-981. 2 | EM REPORTS’ LLSA STUDY GUIDE 2022 length-of-stay (LOS); prespecified E