A 63 year old male arrives via EMS in acute respiratory distress. Medics note he is in atrial fibrillation with a heart rate in the 150s. You ponder the age old question as you walk to the resuscitation bay: "Is the high heart rate causing the respiratory distress or vice versa?"

Here is your quick guide to rate and rhythm control of atrial fibrillation with rapid ventricular response.

Ever wonder if all of your patients presenting with recent onset (<48 hrs) atrial fibrillation and a rapid ventricular response really need to be admitted? Is there evidence of a safe and effective treat and street algorithm that EM physicians can employ? Read on for a review of the Ottawa Aggressive Protocol for rapid afib that enables discharge of 97% of patients!

It is understood that chronic conditions such as hypertension, coronary artery disease, heart failure, hypertrophic cardiomyopathy, and valvular disease (just to name a few) are risk factors for the development of atrial fibrillation. However, in the ED it is important that we are aware of the acute triggers of atrial fibrillation, some of which are associated with significant morbidity and mortality.