Stiell IG, Clement CM, Perry JJ, Vaillancourt C, Symington C, Dickinson G, et al. Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter. CJEM. 2010 May;12(3):181–191. PMID 20522282
There is big controversy over rate v rhythm in AF, and in ED management. I haven’t done this much, but the few times I have it’s been sedation and electricity. I’ve never used procainamide which perhaps reflects my ignorance rather than standard practice.
Anyhow. The big names in this are the Canadians and this is a study of it.
- a chart review to document what they had been already doing for years in Ottawa Aggressive Protocol
- as expected, procainamide followed by a shock if needed. Only in <48 hrs
- two separate nurses abstracted charts, no detail on the methods (ie how they defined terms) here but most of it is pretty solid data
- follow-up was loose (they just checked the record to see if anything bad happened) so it’s hard to know what happened after the visit but probably most were fine
- 1000 pts, 600 of whom entered protocol. The ones who didn’t were because of >48 hr duration
- 40% got some rate control (metoprolol or diltiazem) prior to procainamide
- 35% needed DCC following failure of procainamide
- 7% had a low BP briefly during the procainamide
- 8% had a recurrence in a week needing management (not sure what this means…)
- there is a smaller and similar chart review in AEM in 2007 PMID 18045891
I have little experience of this, and this is, of course, not meant to be evidence that it’s better than anything. But if you are going to do it then these are some of the numbers you might tell a patient.