Atrial fibrillation (acute onset)
INTRODUCTION: Acute atrial fibrillation is rapid, irregular, and chaotic atrial activity of recent onset. Various definitions of acute atrial fibrillation have been used in the literature, but for the purposes of this review we have included studies where atrial fibrillation may have occurred up to 7 days previously. Risk factors for acute atrial fibrillation include increasing age, cardiovascular disease, alcohol, diabetes, and lung disease. Acute atrial fibrillation increases the risk of stroke and heart failure. The condition resolves spontaneously within 24 to 48 hours in more than 50% of people; however, many people will require interventions to control heart rate or restore sinus rhythm. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent embolism, for conversion to sinus rhythm, and to control heart rate in people with recent-onset atrial fibrillation (within 7 days) who are haemodynamically stable? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 26 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: amiodarone, antithrombotic treatment before cardioversion, atenolol, bisoprolol, carvedilol, digoxin, diltiazem, direct current cardioversion, flecainide, metoprolol, nebivolol, propafenone, sotalol, timolol, and verapamil.
Lip GYH and Apostolakis S. Atrial fibrillation (acute onset). Clinical Evidence 2014; 11:210.
Substantive changes at this update
Direct current cardioversion for rhythm control New RCT added. Categorisation unchanged (likely to be beneficial).
Bisoprolol for rate control New option. No evidence found. Categorised as unknown effectiveness.
Metoprolol for rate control New option. No evidence found. Categorised as unknown effectiveness.
Atenolol for rate control New option. No evidence found. Categorised as unknown effectiveness.
Nebivolol for rate control New option. No evidence found. Categorised as unknown effectiveness.
Carvedilol for rate control New option. No evidence found. Categorised as unknown effectiveness.
Rated by doctors in Relevance Newsworthiness Internal Medicine ***** **** Respirology/Pulmonology **** *** Surgery - Thoracic ****** ******
Rated by doctors in Relevance Newsworthiness General Practice(GP)/Family Practice(FP) ***** **** General Internal Medicine-Primary Care(US) ***** **** Internal Medicine **** *** Cardiology ***** **** Hematology/Thrombosis ***** *****