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BET 4. BETA-BLOCKERS OR DIGOXIN FOR RATE CONTROL OF ACUTE ATRIAL FIBRILLATION IN THE EMERGENCY DEPARTMENT

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Report by Martin Hossack, Medical Student

Checked by Rick Body, Specialist Registrar

Institution: Manchester Royal Infirmary

A short-cut review was carried out to establish whether beta-blockers are better than digoxin at safely controlling heart rate in patients with atrial fibrillation. A total of 525 papers was found using the reported search. None presented any evidence to answer the clinical question. It is concluded that there is no direct evidence available to guide this decision and that expert advice should be followed.

CLINICAL SCENARIO

A 60-year-old man comes to the emergency department with palpitations. An ECG confirms atrial fibrillation, with a ventricular rate of 140. He tells you he has been experiencing palpitations for 4 days. There are no signs of haemodynamic instability and you …

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