PGS, I hear what you're saying..however, someone going into AF is *usually* not an acute, must intervene stat, situation..unless of course the folk that come thru the ER waited too long..I do know that for some patients, as long as the ventricular rate is good[using anti-arrhythics if needed], other vital signs good, they'll let the patient hang in AF if the first set of interventions to break the AF don't work..but yes, a patient whose cardiac output is decompensating, and not responding to first-line antiarrhymics, I'd go for the paddles..as I know the cardio's do this..
Your point about it being compared to placebo vs. head to head with current is an important one I will heed..
Amiodorone is aweful re: SE's..I mean aweful.. it has a long half-life so it takes a while to get the right level and takes on average of 3 months to completely clear out!(I think this is what they meant by 'skillful', can cause many other organ issues, patients feel like crap on it, on and on..I haven't consulted a cardiologist on this recently but I can't imagine the doc's not welcoming something like RSD and its SE profile with even non-inferiority..
I'm wondering whether the doc's at your center, because it is a world heart center, have been desensitized to the complexity of what they do and that there are relatively few hospital ER's that can handle what they do every day..
Thanks for pointing to the efficacy data and lack of head to head..this deserves attention
Elisabeth |
