For cardioversion of atrial fibrillation, is a strategy of drug–shock more effective than a shock-only and does pad placement make a difference?

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Why is this study important?

There exists a high degree of variation in management approaches for recent-onset atrial fibrillation and flutter (RAFF) patients treated in academic emergency departments (EDs).[1] This study sought to identify the most effective strategy of cardioversion by comparing 2 protocols: 1) procainamide followed by electrical (DC) cardioversion (drug–shock); and 2) DC cardioversion alone (shock-only) with anteroposterior and anterolateral pad positions.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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