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In 2018, the Canadian Cardiovascular Society (CCS) published a FocusedUpdate of guidelines for themanagement of atrial fibrillation (AF). Some of the updates differ from the Canadian Association of Emergency Physicians (CAEP) 2018 Acute AF Best Practices Checklist. For emergency department (ED) physicians, the CCS 2018 Update suggested two significant changes: 1) a restriction on which patients can safely undergo cardioversion and 2) an advisory that all acute AF patients undergoing cardioversion be prescribed four weeks of anticoagulation, regardless of age or comorbidity. Bothwere “weak recommendation status” based upon “low quality evidence” according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. These changes were controversial, prompting two additional articles in the Canadian Journal of Cardiology, one by the leaders of the CCS changes and the other by the authors of this commentary. Here we summarize the main issues as they relate to management of acute AF by ED physicians.

The Canadian Cardiovascular Society 2018 guideline update for atrial fibrillation – A different perspective