Is Immediate Cardioversion Necessary in New Onset Atrial Fibrillation? Interview with:

Atrial Fibrillation  Wikipedia example

Atrial Fibrillation
Wikipedia example

Harry J.G.M Crijns, MD, PhD
University Hospital Maastricht
Maastricht, The Netherlands What is the background for this study? What are the main findings? 

Response: An episode of the heart rhythm disorder ‘atrial fibrillation’ is a frequent reason for a visit to the Emergency Department. Patients commonly undergo a cardioversion to restore sinus rhythm – either electrical or pharmacological. However, it is known that episodes of atrial fibrillation frequently terminate spontaneously. Therefore, we conducted a multicenter randomized clinical trial in the Netherlands, researching whether a wait-and-see approach – consisting of heart rate slowing drugs and cardioversion only if the heart rhythm does not resolve spontaneously – was non-inferior to the current standard of care of immediate cardioversion.

The primary end point was the presence of sinus rhythm on the ECG at the 4 weeks visit, which was present in 91% in the wait-and-see approach and 94% in the standard of care, which was within the non-inferiority margin.

In the wait-and-see approach, 69% of patients returned to sinus rhythm spontaneously, i.e. without cardioversion. Complications were rare and comparable in both treatment arms, and the percentage of patients experiencing a recurrence of atrial fibrillation during the first 4 weeks after the index visit was comparable (30% vs 29% respectively). We concluded that in patients presenting to the emergency department with recent-onset, symptomatic atrial fibrillation, a wait-and-see approach was non-inferior to early cardioversion in achieving a return to sinus rhythm at 4 weeks. What should readers take away from your report?

Response: Recent-onset symptomatic atrial fibrillation usually terminates spontaneously and therefore an acute cardioversion is not always necessary, as a wait-and-see approach is equally effective and safe. Quality of life is the same in both treatment options. Physicians should discuss with their patients which one of the two approaches – wait-and-see or immediate cardioversion – would be more suitable in their situation. What recommendations do you have for future research as a result of this work? 

Response: Now that we have shown that early, i.e. immediate cardioversion may not be necessary, we are planning future studies on how to implement a delayed cardioversion into daily practice. Is there anything else you would like to add?

Response: Funding for this trial was provided by the Netherlands Organization for Health Research and Development, and Boehringer Ingelheim. 



 Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation
Nikki A.H.A. Pluymaekers, M.D., Elton A.M.P. Dudink, M.D., Ph.D., Justin G.L.M. Luermans, M.D., Ph.D., Joan G. Meeder, M.D., Ph.D., Timo Lenderink, M.D., Ph.D.,
Jos Widdershoven, M.D., Ph.D., Jeroen J.J. Bucx, M.D., Ph.D.,
Michiel Rienstra, M.D., Ph.D., Otto Kamp, M.D., Ph.D.,

Jurren M. Van Opstal, M.D., Ph.D., Marco Alings, M.D., Ph.D.,
Anton Oomen, M.D., and Harry J.G.M. Crijns, M.D., Ph.D
et al., for the RACE 7 ACWAS Investigators*

March 18, 2019
DOI: 10.1056/NEJMoa1900353







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Work Stress Associated With Increase Risk of Atrial Fibrillation Interview with:


Atrial Fibrillation-

Eleonor Fransson, PhD
Associate Professor in Epidemiology
Department of Natural Sciences and Biomedicine
School of Health and Welfare
JÖNKÖPING UNIVERSITY What is the background for this study?

Response: Atrial fibrillation is a very common heart rhythm disorder affecting a large number of people in the population, but there is limited knowledge about risk factors for the disease. This is especially true when it comes to the role of occupational factors. What are the main findings?

Response: We found that work stress measured as job strain, that is, a combination of having high psychological job demands and low control over the work situation, was associated with almost 50% increased risk of atrial fibrillation. When we combined the results from our study with two previously published studies on the same topic, we found that work stress was associated with 37% increased risk.

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NOACs For Atrial Fib Anticoagulation May Have Lower Risk of Kidney Side Effects

Atrial Fibrillation - Wikipedia image

Normal rhythm tracing (top) Atrial fibrillation (bottom) Wikipedia

Interview with:
Dr Xiaoxi Yao PhD
Assistant Professor
Mayo Clinic

What is the background for this study? What are the main findings?

Response: Lifelong oral anticoagulation, either with warfarin or a non-vitamin K antagonist oral anticoagulant (NOAC), is indicated for stroke prevention in most patients with atrial fibrillation (AF). Emerging evidence suggests that NOACs may be associated with better renal outcomes than warfarin.

The study found renal function decline is common among patients with atrial fibrillation treated with oral anticoagulants. NOACs, particularly dabigatran and rivaroxaban, may be associated with lower risks of adverse renal outcomes than warfarin.

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