Acute Atrial Fibrillation and Flutter Treated Electively

STATUS

Recruiting
End date

Jun 29, 2026
participants needed

500
sponsor

Tampere University

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Updated on 19 February 2024

See if I qualify

arrhythmia

thromboembolism

fibrillation

cardioversion

antiarrhythmic drug

flecainide

atrial flutter

Summary

The AFFELECT -study compares two types of treatment modalities for acute atrial fibrillation or flutter for patients in whom rhythm control is desirable. The main purpose is to observe if these arrhythmias can be safely treated electively (within 5-9 days).

All patients are recruited in the emergency department. Patients must be in good clinical condition so that they can be discharged regardless to which treatment modality is randomly selected to them. Patients randomized to conventional care are treated conventionally which means acute rhythm control is applied by electrical or medical cardioversion in the emergency department (within 48 hours of onset of the arrhythmia). Patients randomized to elective care are discharged immediately after adequate temporary rhythm control is assured.

All patients will visit a cardiologist out-patient clinic at approximately one week after the emergency room visit. Patients randomized to elective treatment and still in atrial fibrillation or in atrial flutter will be restored to sinus rhythm by electrical or medical cardioversion at the out-patient clinic. Cardiovascular status and treatment options are evaluated for all patients.

Anticoagulation is managed according existing guidelines for all patients. Due to possibility of delayed cardioversion in the interventional group (elective care group), all patients receive anticoagulation before the out-patient clinic despite their thromboembolic risk. All patients who have not received adequate anticoagulation for three weeks prior to the delayed cardioversion will undergo a transesophageal cardiac ultrasound to ensure they are not in excess risk for thromboembolic events. Patients randomized to elective treatment have the possibility to opt-out and undergo acute cardioversion if their symptoms are unmanageable during the first week before the out-patient clinical.

All patients are monitored for their symptoms by a standardized quality-of-life questionnaire and for possibly required acute medical interventions during the first week and one month after the out-patient clinic. After one month, all patients undergo an electrocardiography (ECG) to ensure the maintenance of normal rhythm in both treatment groups. After the months follow-up all patients are subsequently monitored for a maximum of five years for need of medical interventions due to atrial fibrillation of atrial flutter. New antiarrhythmics such as flecainide are not prescribed during the first month.

Details

Condition	Arrhythmia, Arrhythmia, Atrial Flutter, Atrial Flutter, Atrial Fibrillation, Atrial Fibrillation
Age	100years or below
Treatment	Acute cardioversion, Delayed cardioversion
Clinical Study Identifier	NCT04267159
Sponsor	Tampere University
Last Modified on	19 February 2024

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Eligibility		Yes	No	Not Sure
Inclusion Criteria
	Patients presenting with acute (<48hours) atrial fibrillation or atrial flutter to ER
	Planned acute rhythm control for the arrhythmia by the attending physician in ER
	Good perceived health as assessed by attending physician in ER
	Resting heart rate 110bpm or lower before or after adequate rate control therapy
Exclusion Criteria
	Haemodynamically stable (mean arterial pressure above 60mmHg)
	Need for acute restoration of sinus rhythm due to some other somatic cause
	No other major complicating acute illness (e.g. decompensated HF or acute MI)
	Anticoagulation not safe
	Mechanical heart valve or mitral stenosis
	The need for prolonged (>24h) hospitalization due to any cause
	Exceptionally high risk for thromboembolic events (e.g. history of thromboembolic stroke regardless of adequate anticoagulation)
	Transesophageal echocardiography contraindicated

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Acute Atrial Fibrillation and Flutter Treated Electively