Abstract
In this Viewpoint concerns raised by Canadian emergency physicians regarding recommendations
2 and 6 from the recent Canadian Cardiovascular Society 2018 update for atrial fibrillation
are discussed. These recommendations narrow the window for safe cardioversion and
suggest 4 weeks of anticoagulation for all patients who undergo urgent cardioversion
regardless of their CHADS-65 status. We discuss the implications of Grading of Recommendations,
Assessment, Development, and Evaluation weak recommendations on the basis of low-quality
evidence.
Résumé
Il est question dans ce point de vue des préoccupations soulevées par des urgentologues
canadiens concernant les recommandations 2 et 6 provenant de la récente mise à jour
2018 des lignes directrices de la Société canadienne de cardiologie en matière de
fibrillation auriculaire. Ces recommandations réduisent la fenêtre pendant laquelle
il est sûr d’effectuer une cardioversion et suggèrent l’administration d’un anticoaguant
pendant 4 semaines à tous les patients qui subissent une cardioversion d’urgence,
sans égard au score CHADS-65. Nous traitons de l’incidence qu’a la méthodologie GRADE
(Grading of Recommendations Assessment, Development and Evaluation) à l’endroit des recommandations faibles reposant sur des données probantes de faible
qualité.
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Article info
Publication history
Published online: June 13, 2019
Accepted:
June 5,
2019
Received:
May 10,
2019
Footnotes
See article by Andrade and Mitchell, pages 1301–1310 of this issue.
See page 1300 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Periprocedural Anticoagulation for Cardioversion of Acute Onset Atrial Fibrillation and Flutter: Evidence Base for Current GuidelinesCanadian Journal of CardiologyVol. 35Issue 10
- PreviewThe practice of electrical or pharmacological cardioversion (CV) to restore sinus rhythm in patents with symptomatic atrial fibrillation (AF) or atrial flutter has been a part of clinical practice for more than 100 years. For almost as long as CV has been performed, it has been recognized that the act of restoring sinus rhythm is associated with an increased risk of stroke and systemic embolism, and that oral anticoagulant (OAC) therapy can be used to prevent peri-CV thromboembolism. Although it has been widely accepted that OAC therapy is necessary to prevent thromboembolism in patients with chronic AF/atrial flutter who undergo CV, previous clinical practice recommendations have suggested that OAC therapy may be omitted in patients at low risk of stroke.
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