Chemical vs Electrical Cardioversion for Emergency Department Patients With Acute Atrial Fibrillation
Atrial Fibrillation
About this trial
This is an interventional treatment trial for Atrial Fibrillation
Eligibility Criteria
Inclusion Criteria:
- Must have an abnormal heart rhythm diagnosed as AF for less than 48 hours.
- Be eligible for cardioversion (in the judgment of the study doctor).
- Are on the appropriate blood thinner medications.
- Have systolic blood pressure (SBP) above 90 mmHg and less than 160 mmHg and diastolic blood pressure (DBP) less than 95 mmHg at screening and baseline.
- Are adequately hydrated (in the judgment of the study doctor) and have a normal saline intravenous established and it is working properly.
- Must have a body weight between 45 and 136 kg inclusive (99 and 300 lbs).
- Be able and willing to give informed consent.
Exclusion Criteria:
- Pregnant or nursing a child
- Are diagnosed with any other serious lung, liver, metabolic, kidney, gastrointestinal, central nervous system, or psychiatric disease, infection, having a fever, end stage disease states, or any other diseases that could interfere with the conduct of this study. Your study doctor will confirm this with you.
- Have an infection or fever
- Are allergic to procainamide (the chemical conversion agent) or propofol (the sedative agent)
- Are participating in another drug study or have received an experimental drug within 30 days prior to screening in this study
- Are not currently living in the Vancouver Coastal Health Region
- Are unable or unwilling to be contacted at 30 days by one of the study doctors or study staff to determine 30-day outcomes
- Are unwilling to sign the informed consent form
- Are unable to speak English
Sites / Locations
- St Paul's Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Electrical-first
Chemical-first
Patients in atrial fibrillation for less than 48 hours will be administered procedural sedation and analgesia and an electrical current applied across their chest (cardioversion) to attempt conversion to normal sinus rhythm. If this does not succeed, they will be given intravenous procainamide (chemical cardioversion). If procainamide is required, physicians will be informed as follows: "50% of patients convert to normal sinus rhythm within one hour and 90% of patients convert within two hours." Physicians can then proceed at their discretion.
Patients in atrial fibrillation for less than 48 hours will be administered intravenous procainamide (chemical cardioversion) to attempt conversion to normal sinus rhythm. If procainamide is required, physicians will be informed as follows: "50% of patients convert to normal sinus rhythm within one hour and 90% of patients convert within two hours." Physicians can then proceed at their discretion. If this does not succeed, patients will be administered procedural sedation and analgesia and an electrical current applied across their chest (electrical cardioversion) to attempt conversion to normal sinus rhythm.