In this large cohort of 660 patients presenting with new onset fib/flutter, patients were managed with the Ottowa Aggressive Protocol, which utilized IV procainamide, then electrical cardioversion if necessary, then discharge home. In this cohort, 97% of patients were discharged home from the ED (93% of which were in sinus rhythm). The median length of stay in the ED was 5 hours, and the 7 day relapse rate was 9%. This protocol appears to be safe and effective in obviating the need for admission of most patients with new onset afib/flutter (abstract)
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