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2014 ; 2014
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Atrial fibrillation (acute onset)
#MMPMID25430048
Lip GY
; Apostolakis S
BMJ Clin Evid
2014[Nov]; 2014
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INTRODUCTION: Acute atrial fibrillation is rapid, irregular, and chaotic atrial
activity of recent onset. Various definitions of acute atrial fibrillation have
been used in the literature, but for the purposes of this review we have included
studies where atrial fibrillation may have occurred up to 7 days previously. Risk
factors for acute atrial fibrillation include increasing age, cardiovascular
disease, alcohol, diabetes, and lung disease. Acute atrial fibrillation increases
the risk of stroke and heart failure. The condition resolves spontaneously within
24 to 48 hours in more than 50% of people; however, many people will require
interventions to control heart rate or restore sinus rhythm. METHODS AND
OUTCOMES: We conducted a systematic review and aimed to answer the following
clinical questions: What are the effects of interventions to prevent embolism,
for conversion to sinus rhythm, and to control heart rate in people with
recent-onset atrial fibrillation (within 7 days) who are haemodynamically stable?
We searched: Medline, Embase, The Cochrane Library, and other important databases
up to April 2014 (Clinical Evidence reviews are updated periodically; please
check our website for the most up-to-date version of this review). We included
harms alerts from relevant organisations such as the US Food and Drug
Administration (FDA) and the UK Medicines and Healthcare products Regulatory
Agency (MHRA). RESULTS: We found 26 studies that met our inclusion criteria. We
performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review, we present information relating to the
effectiveness and safety of the following interventions: amiodarone,
antithrombotic treatment before cardioversion, atenolol, bisoprolol, carvedilol,
digoxin, diltiazem, direct current cardioversion, flecainide, metoprolol,
nebivolol, propafenone, sotalol, timolol, and verapamil.