Flecainide Versus Amiodarone in the Cardioversion of Paroxysmal Atrial Fibrillation at the Emergency Department, in Patients With Coronary Artery Disease Without Residual Ischemia

Exclusion Criteria

• •1. Based on ECG at the Emergency Department:
• •1. Atrial Flutter
• •2. Newly documented Left Bundle Branch Block (LBBB)
• •3. Newly documented Right Bundle Branch Block (RBBB) with QRS duration \> 150ms
• •2. Previously documented 24-hour ECG holter monitoring with \> 720 poly PVCs/24hours, or non sustained ventricular tachycardia
• •3. No history of coronary artery disease
• •4. ST-Segment Elevation Myocardial Infarction (STEMI)
• •5. Non-ST-Segment Elevation Myocardial Infarction (NSTEMI), according to ESC 2020 guidelines on NSTEMI:
• •1. If troponin at t0h is over the "low" criterion on table of the cutoff values
• •2. If the change of troponin (Δtroponin) at t1h is over the respective cutoff value at the table for the cutoff values
• •6. Unstable angina, defined as myocardial ischemia at rest or at minimum effort, in the absence of acute injury/necrosis of myocardial cells
• •7. Known residual ischemia:
• •1. Positive imaging-based stress testing
• •2. Negative imaging-based stress testing \>= 1 year, and:
• •* History of known coronary artery stenosis \> 60% without revascularization, or
• •* PCI \>= 1 year, or
• •* CABG \>= 3 years
• •8. History of acute coronary syndrome within 1 year
• •9. Severe Aortic Valve Stenosis (mean pressure gradient \> 40mmHg, AVA \< 1cm/m\^2)
• •10. Severe Chronic Kidney Disease (stage \>= 4)
• •11. Severe systematic disease, including neoplasmatic disease under any antineoplasmatic treatment, liver failure, infection with fever
• •12. Use of strategy "pill in the pocket", by taking flecainide (max 200mg) or propafenone (max 600mg) within 6 hours prior to Emergency Department visit
• •13. Known dysanexia or allergy to flecainide or amiodarone
• •14. Pregnancy or/and breastfeeding
• •15. Participation in any other clinical trial
• •16. Life expectancy less than 1 year
• •17. Inappropriate, unfit, or unwilling to follow the desingated protocol procedures.