Schwartz/Reisman Emergency Medicine Institute

The RAFF-2 Study

A Randomized, Controlled Comparison of Electrical versus Pharmacological Cardioversion for Emergency Department Patients with Recent Onset Atrial Fibrillation or Atrial Flutter (RAFF)

Recent-onset episodes of atrial fibrillation and atrial flutter (RAFF) are cardiac rhythm problems where there is an irregular, rapid heart rate. Previous research has shown that doctors use a wide variety of treatment approaches in emergency departments (EDs) for RAFF and the Canadian Cardiovascular Society Guidelines indicate there have not been enough studies to know if the best treatment is to use an electrical shock (Shock Only) or drugs followed by shock (Drug-Shock).

SREMI researchers have partnered with Dr. Jeff Perry and Dr. Ian Stiell from the Ottawa Hospital Research Institute and investigators from 8 large Canadian EDs on a $1.2 million CIHR project that will study ED patients with rapid heart rate requiring urgent treatment to restore normal heart rhythm. We intend to conduct 2 randomized protocols within 1 study (partial factorial design) in order to answer 2 questions:

1. Will initial drug treatment followed by electrical shock if necessary (Drug-Shock) lead to more patients being converted to normal heart rhythm than a strategy of only electrical shock (Shock Only)?

2. Will the antero-posterior (back) pad position be more effective than the antero-lateral (front) position?

We hope to improve upon and standardize care, so that more ED RAFF patients are quickly and safely converted to sinus rhythm. We believe the results from this study will inform future efforts to create effective, safe, and efficient pathways for RAFF patient management in Canada.