Cardioversion of Paroxysmal Atrial Fibrillation in the Emergency Department

Michael, John A; Stiell, Ian G.; Agarwal, Sanjay; Mandavia, Diku

doi:10.1016/s0196-0644(99)70300-8

Cited by 109 publications

(83 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast with other studies, 12 almost all of our patients received primary electrical cardioversion; few had preceding rate control or antiarrhythmic drug therapy. Six patients required assisted ventilations with a bag-valve mask during the sedation procedure, but no other adverse events were seen, no patients had a change in disposition as a result of their treatment, and only a few patients had repeat ED visits, subsequent DCCVs, or hospitalizations within 30 days.…”

Section: Discussioncontrasting

confidence: 76%

“…However, this is less time than the 11.8 hours reported by Koenig et al, 28 the 10.1 hours reported by Decker et al, 14 and the 9 hours reported by Domanovits et al 29 and comparable to the 5 hours reported by Michael et al. 12 Other investigators have found that a greater percentage of patients undergo a trial of chemical rhythm control prior to electrical cardioversion, but most patients in our study were only managed with DCCV. The speed and apparent safety of our primary electrical approach may result in lower system utilization for patients requiring conversion.…”

Section: Discussionsupporting

confidence: 54%

“…Two other ED-based studies found similar low adverse event rates. 12,13 In our 8-year review of DCCV for ED patients with atrial fibrillation or flutter, there were few short-term adverse events and no 30-day complications related to the procedure. The age, sex, and risk profile of our patients is consistent with prior ED-based studies, [14][15][16][17] although the CHADS 2 score has not been reported previously.…”

Section: Discussionmentioning

confidence: 81%

“…[12][13][14] A prospective ED trial (n = 56) demonstrated no 6-month strokes, thromboembolic events, or deaths. 15 Recent meta-analyses have concluded that patients undergoing electrical cardioversion for atrial fibrillation lasting ‡7 days have a tendency toward increased stroke risk compared to patients treated with rhythm control alone.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Thirty‐day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter

Scheuermeyer

Grafstein

Stenstrom

et al. 2010

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: While the short-term (<7-day) safety and efficiency of electrical cardioversion for emergency department (ED) patients with atrial fibrillation or flutter have been established, the 30-day outcomes with respect to stroke, thromboembolic events, or death have not been investigated.Methods: A two-center cohort of consecutive ED patients undergoing cardioversion for atrial fibrillation or flutter between January 1, 2000, and September 30, 2007, was retrospectively investigated. This cohort was probabilistically linked with both a regional ED database and the provincial health registry to determine which patients had a subsequent ED visit or hospital admission, stroke, or thromboembolic event or died within 30 days. In addition, trained reviewers performed a detailed chart abstraction on 150 randomly selected patients, with emphasis on demographics, vital signs, medical treatment, and predefined adverse events. Hemodynamically unstable patients or those whose condition was the result of an underlying acute medical diagnosis were excluded. Data were analyzed by descriptive methods.Results: During the study period, 1,233 patients made 1,820 visits for atrial fibrillation or flutter to the ED. Of the 400 eligible patients undergoing direct-current cardioversion (DCCV), no patients died, had a stroke, or had a thromboembolic event in the following 30 days (95% confidence interval [CI] = 0.0 to 0.8% for all outcomes). A total of 141 patients were included in the formal chart review, with five patients (3.5%, 95% CI = 0.5% to 6.6%) failing cardioversion, six patients (4.3%, 95% CI = 0.9% to 7.6%) having a minor adverse event that did not change disposition, and five patients (3.5%, 95% CI = 0.5% to 6.6%) admitted to hospital at the index visit.Conclusions: Cardioversion of patients with atrial fibrillation or flutter in the ED appears to have a very low rate of long-term complications.ACADEMIC EMERGENCY MEDICINE 2010; 17:408-415 ª

show abstract

Section: Discussioncontrasting

confidence: 76%

Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 81%

mentioning

confidence: 99%

See 2 more Smart Citations

Thirty‐day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter

Scheuermeyer

Grafstein

Stenstrom

et al. 2010

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…This conclusion has been supported by several other observational studies that found the risk of thromboembolism to be negligible (ranging from 0-0.9%) in patients who undergo cardioversion for AF of <48 hours from symptom onset. [14][15][16][17][18][19][20] More recently, the Fin-CV study examined over 3,000 patients with AF of estimated duration <48 hours who were cardioverted by either pharmacological or electrical intervention. 21 They confirmed that overall the risk of cardioverting patients with AF of <48 hours was low (0.7%), with 38 thromboembolic events occurring within 30 days following cardioversion.…”

Section: Risk Of Thromboembolism Following Cardioversionwhere Does Thmentioning

confidence: 99%

Cardioverting acute atrial fibrillation and the risk of thromboembolism: not all patients are created equal

Rankin

2017

Clinical Medicine

View full text Add to dashboard Cite

Current guidelines support the well-established clinical practice that patients who present with atrial fi brillation (AF) of less than 48 hours duration should be considered for cardioversion, even in the absence of pre-existing anticoagulation. However, with increasing evidence that short runs of AF confer signifi cant risk of stroke, on what evidence is this 48-hour rule based and is it time to adopt a new approach? We review existing evidence and suggest a novel approach to risk stratifi cation in this setting. Overall, the risk of thromboembolism associated with acute cardioversion of patients with AF that is estimated to be of <48 hours duration is low. However, this risk varies widely depending on patient characteristics. From existing evidence, we show that using the CHA 2 DS 2 -VASc score may allow better selection of appropriate patients in order to prevent exposing specifi c patient groups to an unacceptably high risk of a potentially devastating complication. KEYWORDS : Anticoagulants , atrial fi brillation , cardioversion , electrical cardioversion , stroke , thromboembolism IntroductionInternational guidelines support the well-established clinical practice that patients who present with non-valvular atrial fibrillation (AF) of less than 48 hours duration should be considered for cardioversion, even in the absence of pre-existing anticoagulation.1,2 The risk with more prolonged periods of AF is that restoration of sinus rhythm may precipitate embolism of intra-atrial thrombus causing stroke. However, with increasing evidence that even short runs of AF confer significant risk of stroke, [3][4][5][6] this review examines the evidence supporting the '48-hour rule' and suggests a novel approach to risk stratification in this setting. Search strategy and selection criteriaData for this review were identified by searches of PubMed using combinations of the terms 'atrial fibrillation', 'cardioversion' and 'thromboembolism'. References sourced ABSTRACTCardioverting acute atrial fi brillation and the risk of thromboembolism: not all patients are created equal from relevant articles were also included. Additional references were identified from review of current international guidelines on the management of atrial fibrillation.

show abstract

Atrial Fibrillation

Khoo

Lip

2012

Cardiovascular Clinical Trials

View full text Add to dashboard Cite

Cardioversion of Paroxysmal Atrial Fibrillation in the Emergency Department

Cited by 109 publications

References 7 publications

Thirty‐day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter

Thirty‐day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter

Cardioverting acute atrial fibrillation and the risk of thromboembolism: not all patients are created equal

Atrial Fibrillation

Contact Info

Product

Resources

About