The Timing of Cardioversion in AF

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.