000			03442nab a2200289 4500
999			_c12943 _d12943
003			CO-MdCUR
005			20190726110638.0
007			ta
008			170814s2019 xxu||||| |||| 00| 0 eng d
040			_cRemington _aCO-MdCUR _erda
041			_aeng
082			_221
773	0		_011137 _923482 _aMassachusetts Medical Society _dBoston, Massachusetts Medical Society. _o19654 _tThe New England journal of medicine. _w11137412 _x0028-4793
100	1		_939358 _aPluymaekers, Nikki A.H.A.
245	1		_aEarly or Delayed Cardioversion in Recent-Onset Atrial Fibrillation
264			_aBoston : _bMassachusetts Medical Society , _c2019
300			_apáginas 1499 - 1508
520	3		_aBACKGROUND Patients with recent-onset atrial fibrillation commonly undergo immediate restoration of sinus rhythm by pharmacologic or electrical cardioversion. However, whether immediate restoration of sinus rhythm is necessary is not known, since atrial fibrillation often terminates spontaneously. METHODS In a multicenter, randomized, open-label, noninferiority trial, we randomly assigned patients with hemodynamically stable, recent-onset (<36 hours), symptomatic atrial fibrillation in the emergency department to be treated with a wait-and-see approach (delayed-cardioversion group) or early cardioversion. The wait-and-see approach involved initial treatment with rate-control medication only and delayed cardioversion if the atrial fibrillation did not resolve within 48 hours. The primary end point was the presence of sinus rhythm at 4 weeks. Noninferiority would be shown if the lower limit of the 95% confidence interval for the between-group difference in the primary end point in percentage points was more than −10. RESULTS The presence of sinus rhythm at 4 weeks occurred in 193 of 212 patients (91%) in the delayed-cardioversion group and in 202 of 215 (94%) in the early-cardioversion group (between-group difference, −2.9 percentage points; 95% confidence interval [CI], −8.2 to 2.2; P=0.005 for noninferiority). In the delayed-cardioversion group, conversion to sinus rhythm within 48 hours occurred spontaneously in 150 of 218 patients (69%) and after delayed cardioversion in 61 patients (28%). In the early-cardioversion group, conversion to sinus rhythm occurred spontaneously before the initiation of cardioversion in 36 of 219 patients (16%) and after cardioversion in 171 patients (78%). Among the patients who completed remote monitoring during 4 weeks of follow-up, a recurrence of atrial fibrillation occurred in 49 of 164 patients (30%) in the delayed-cardioversion group and in 50 of 171 (29%) in the early-cardioversion group. Within 4 weeks after randomization, cardiovascular complications occurred in 10 patients and 8 patients, respectively. CONCLUSIONS In patients presenting to the emergency department with recent-onset, symptomatic atrial fibrillation, a wait-and-see approach was noninferior to early cardioversion in achieving a return to sinus rhythm at 4 weeks. (Funded by the Netherlands Organization for Health Research and Development and others; RACE 7 ACWAS ClinicalTrials.gov number, NCT02248753.)
650		0	_98005 _aFibrilación auricular
700	1		_939359 _aDudink, Elton A. M. P.
700	1		_939360 _aLuermans, Justin G. L. M.
942			_2ddc _cHEM