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Jeffrey Tabas, MD, on New Research for Atrial Fibrillation

In this podcast, Jeffrey Tabas, MD, shares his thoughts on the next steps for research on atrial fibrillation, including the types of studies still needed. 

For more parts of this series, visit our resource center for the American College of Emergency Physicians 2021 Scientific Assembly.


Jeffrey Tabas, MD, is a professor of emergency medicine at the University of California, San Francisco’s School of Medicine, an emergency medicine physician at Zuckerberg’s San Francisco General Emergency Department, the director of faculty development for the Department of Emergency Medicine, and the director of Outcomes and Innovations for the UCSF Office of Continuing Medical Education.


 

TRANSCRIPTION:

Amanda Balbi: Hello and welcome to a special series of Podcasts360. I’m your moderator, Amanda Balbi. In this 6-part series, we will be speaking with Dr Jeffrey Tabas, who is a professor of emergency medicine at the University of California, San Francisco’s School of Medicine, an emergency medicine physician at Zuckerberg’s San Francisco General Emergency Department, the director of faculty development for the Department of Emergency Medicine, and the director of Outcomes and Innovations for the UCSF Office of Continuing Medical Education.

He recently presented a session on atrial fibrillation at the American College of Emergency Physicians 2021 Scientific Assembly. In part 6 of this podcast series, he shares his thoughts on the next steps in research for atrial fibrillation. 

Let’s listen in as he answers our questions.

Is there anything maybe as a next step in this research that you're keeping an eye on?

Jeffrey Tabas: I think the next step is clarifying a little better whether patients who are CHA2DS2-VASc score of 1 for men and 2 for women should be anticoagulated. I think the recommendation, again, it's a 2b recommendation from the European Society of Cardiology and just from the experience from my tennis partner, I think that the risk of a major bleed compared to a stroke—I'll take the major bleed, personally, unless it's a bleed in the head. That is not nearly close to the rate of stroke that you reduce from being anticoagulated. I think clarifying that so every society is on the same page I think would be helpful.

I think clarifying a little better the emergent cardioversion of recent-onset or acute-onset atrial fibrillation and its impact long term, as opposed to short term, if there's really benefit; I think that will change a lot of things.

In my view, that is equivalent to getting an arthroscopy for cartilage problems in your knee. So many people I know got arthroscopy for cartilage problems in their knee. They felt better afterwards, but when they actually studied it, and they had to study it in a health care system like Scandinavia. When they studied this in Sweden, they found out that for simple degenerative cartilage disease, there was no benefit to having arthroscopy compared to having no arthroscopy. So, unless you had locking or catching or giving way, just pain, there was no benefit to that procedure. 

I think unless there is a real reason that someone needs to be out of their atrial fibrillation, like they're really symptomatic from it, I think that we will find with further research that it doesn't improve outcomes by emergently converting in the ED. But there's good evidence that it's safe, and therefore, I feel that it's not wrong to do if you believe that it's helpful.

Amanda Balbi: Thank you so much for speaking with me today.

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