Here we review the RACE7 ACWAS (Rate Control vs Cardioversion Trial7-Acute Cardioversion versus Wait and See) Trial (1).
What they did
This was a multicenter, randomised, open label, non-inferiority trial.
They wanted to see if a wait and see approach was non-inferior to early cardioversion for obtaining sinus rhythm.
N=437
Patients with symptomatic AF presenting <36 hours after onset, were assigned to delayed vs early cardioversion.
The wait and see group received beta blockers, or calcium channel blockers or digoxin to achieve a heart rate < 110 and relief of symptoms. They were then discharged and referred back for review the next day, at which point if they were still in atrial fibrillation they were cardioverted.
