What Should We Do About A-Fib/Flutter when There Is Another Acute Condition?
Rapid atrial fibrillation or flutter (A-fib/flutter) can be managed by rate or rhythm control, but prior studies have focused on A-fib/flutter occurring in isolation. Now, investigators have retrospectively compared the incidence of adverse events in patients with A-fib/flutter and a serious underlying acute condition who either did or did not undergo rate or rhythm control.
During the 1-year study period, 416 patients at two Canadian emergency departments had A-fib/flutter and other complex acute medical issues. Among 135 patients with attempted rate or rhythm control, 41% had adverse events such as hypotension or intubation. Among 281 patients with no attempted rate or rhythm control, 7% had adverse events. The two groups were similar at baseline in terms of type of acute illness and comorbidities.
This retrospective study does not provide any specific recommendation for practice change, but rather reminds us of the importance of recognizing and addressing intravascular volume and other noncardiac determinants of a rapid ventricular response in A-fib/flutter. When we believe the tachycardia is an appropriate response of the heart to a noncardiac problem, we should be reluctant to suppress it.