​Imagine being a patient with acute atrial fibrillation (AF) in an emergency department at a hospital.  Heart pounding with irregular palpitations, marked weakness throughout the body, simple tasks feeling impossible. The mental toll of fear and uncertainty for what might come next — relief must be around the corner, but how soon can it get here? 

One of the most common heart rhythm disorders, AF is triggered by numerous causes, can be unpredictable and often begins suddenly. While not always life‑threatening, the condition can significantly affect quality of life and, if not properly managed, increase the risk of stroke and other complications, such as damaged heart muscles, cognitive decline and systemic embolisms. When assessing treatment options for urgent care, clinicians must balance the need for rapid symptom control with patient safety and longer‑term management; a tricky problem at any point but especially challenging when symptom relief is at the forefront of patients’ needs.  

A cross-Canada clinical trial led by The Ottawa Hospital recently found that a newer drug called vernakalant reduces AF symptoms faster than the more commonly used drug procainamide. While both medications can restore a regular heart rhythm, patients treated with vernakalant returned to a normal heart rhythm in an average of 22 minutes, compared to 44 minutes for procainamide. Patients treated with procainamide were also more likely to need electrical cardioversion by a controlled shock from a defibrillator.​

The trial, published in The BMJ, included 350 patients across 12 Canadian emergency departments. The study also found that vernakalant was even more effective for patients under 70 years old (73 per cent returning to normal heart rhythm vs 47 per cent for procainamide).

“For patients in acute atrial fibrillation, rapid treatment improves care,” says lead author Dr. Ian Stiell, an emergency physician and senior scientist at The Ottawa Hospital and distinguished professor at the University of Ottawa. “Our goal is to get them back to a regular heart rate and back to their homes as soon as possible. Treatment with vernakalant not only helps patients, but it also helps our emergency departments free up beds and staff sooner.” 

Long-term management of AF can be complex, as treatment depends on individual patient needs. Proper care relies on various factors such as age, how long symptoms have been present, underlying health conditions and the overall stability of the patient, making a standardized approach impractical. The study provides important real‑world evidence that may help clinicians make more informed treatment decisions. 

Beyond individual patient comfort, faster symptom relief may also have broader impacts on the healthcare system. More effective early treatment could shorten emergency department stays, reduce the need for additional interventions and potentially lower the likelihood of patients returning to hospital with recurring symptoms. ​