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How do you cardiovert AF: Drugs of Electricity?

atrial fibrillation electrical vs pharmacological cardioversion papercut May 15, 2024

Atrial Fibrillation is the most common arrhythmia we see. Conversion to sinus rhythm of recent-onset of atrial fibrillation is proven to be safe. How do you cardiovert? Is a pharmacological cardioversion first approach more successful than an electrical cardioversion first approach in acute atrial fibrillation?

The RAFF-2 Trial(1) Gives Us the answer.

What They Did

The was a two-protocol trial conducted in 11 academic hospitals in Canada. It compared the safety and efficacy of procainamide + electrical cardioversion (DCCV) vs. DCCV alone. It also looked at the cardioversion group and looked to assess the best pad positions.

There were two protocols used:

  • Protocol 1: IV procainamide 15mg/kg (max dose 1500mg) given over 30 minutes followed by electrical cardioversion..... Read More 

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