Management of atrial fibrillation in the Emergency Department: current approach and future expectations

Atrial fibrillation (AF) is the most common cardiac dysrhythmia and occurs in 3.3%-10% of emergency admissions. It is fre - quently quoted for people over the age of 75, but the cases of AF in young subjects without struc - tural heart disease are also increasing, there - fore, leading to the evaluation of "lonely atrial fibrillation" as a new challenge for the clinician. The first diagnosis and treatment often occur in the emergency room and the emergency physi - cian has therefore to evaluate the initial step to - wards the therapeutic decisions. Although inter - national standard guidelines are available, AF treatment in the Emergency Department (ED) is still heterogeneous in terms of the management strategy chosen. There are two main strategies for the management of AF: rate and rhythm con - trol. Moreover, antithrombotic treatment is piv - otal in AF to prevent cardioembolic stroke and it is considered a primary objective after an accu - rate assessment of antithrombotic treatment risks and benefits.The introduction of innovative echocardiographic approach, directly in ED, seems to improve the management and risk stratification of patients with AF. This review aims to provide an overview about the current approach and the future expectations in the management of AF in ED. This manuscript represents a synopsis of the lectures on AF man - agement in the ED of theThird Italian GREAT Net - work Congress, that was hold in Rome, 15-19 Oc - tober 2012.We decided to use only the most rele - vant references for each contribution as suggest - ed by each participant at this review.