Start with a free account for 3 free CME credits. Already a subscriber? Sign in.

Paper Chase #2 - Cardioversion in New A-Fib

Steve Biederman, MD and Tom Robertson, MD
00:00
07:20
Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

To determine if immediate cardioversion in recent-onset atrial fibrillation is necessary compared to a wait-and-see approach.

 

To view chapter written summaries, you need to subscribe.

Sign up today for full access to all episodes.

Kapil S. -

Family medicine resident from Alberta Canada here.

I am curious about the secondary endpoints. You didn't mention how many patients in the delayed cardioversion group actually had to go back to ED the next day to get cardioverted. That should be considered because if say 70% or more of those patients had to be cardioverted anyways their total time in ED was actually longer and also cardioversion was required regardless making it actually worse to be in that group from the acute phase. If say only 20% of the group needed delayed cardioversion and then the results were same at follow up 4 weeks later, then it's a benefit. Can you please clarify as this was not clear to me.

Thanks.

Kapil

Neda F., MD -

Thanks for listening and for your question, Kapil! I've asked our Paper Chase guys to weigh in and will keep you posted as soon as I hear back. -- Neda

Neda F., MD -

Hi again, Kapil. Here's Steve's response:

Thanks for listening and for your thoughtful question Kapil! In the delayed group, conversion to sinus rhythm occurred spontaneously 69% of the time (meaning without any electrical or pharmacological cardioversion). 28% of the delayed group did in fact need to return for cardioversion. Your comment about inconvenience and possible extended ED time in the delayed group is certainly valid, and the delayed group had a higher total number of visits because of the 28% patients who needed to go back. I would still argue that if you told me that 4-week outcomes were similar and 69% of those who waited didn’t need cardioversion, I’d strongly consider that option even with the risk of another ED visit. Thanks again!

Steve

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
Primary Care Gets Some Love Full episode audio for MD edition 196:25 min - 92 MB - M4AHippo Primary Care RAP - August 2019 Written Summary 659 KB - PDF

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

0.25 Free AMA PRA Category 1 Credits™ certified by Hippo Education or 0.25 Free prescribed credits by the American Academy of Family Physicians certified by AAFP (2019)

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate

3.25 AMA PRA Category 1 Credits™ certified by Hippo Education or 3.25 prescribed credits by the American Academy of Family Physicians certified by AAFP (2019)

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate