Ottawa Aggressive Protocol for acute atrial fibrillation is successful

May 17 2007

There is no consensus on Emergency Department management of acute atrial fibrillation (AAF) or atrial flutter (AAFL).

The Ottawa Aggressive Protocol, consisting of an IV procainamide infusion of 1 gram over 1 hour, electrical cardioversion, if necessary, by ED staff and discharge from the ED with outpatient cardiology follow-up, may be a safe and effective treatment for AAF and AAFL.

In results to be presented at the 2007 Society for Academic Emergency Medicine (SAEM) Annual Meeting, Dr. Ian Stiell of the Ottawa Health Research Institute will show that in 660 patient visits in a 5 year period, over 90% of all patients with AAF or AAFL can be discharged with a normal heart rhythm using this protocol. This method of treatment stands in contrast to practice in the United States, where management of AAF and AAFL is hospital admission followed by treatment by cardiologists.

Dr. Stiell states, "This is the largest reported study of AAF/AAFL in the ED and demonstrates that the Ottawa Aggressive Protocol is extremely effective for the rapid cardioversion and discharge of patients by ED physicians. This protocol is safe and could lead to a significant decrease in hospital admissions."

The presentation is entitled The Ottawa Aggressive Protocol for ED Management of Acute Atrial Fibrillation by Ian G. Stiell, MD.