Emergency Department Use of Intravenous Procainamide for Patients with Acute Atrial Fibrillation or Flutter

Stiell, Ian G.; Clement, Catherine M.; Symington, Cheryl; Perry, Jeffrey J.; Vaillancourt, Christian; Wells, George A.

doi:10.1197/j.aem.2007.07.016

Cited by 53 publications

(27 citation statements)

References 32 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To our knowledge, this is the first systematic review to evaluate the optimal management of AF/AFL in the ED, specifically with regard ED discharge, regardless of the type of acute management that was chosen or rhythm status at time of discharge. It is interesting to note that the articles in the general management group demonstrated a similar rate of short-term adverse events to the articles in the DCCV and chemical cardioversion groups, many of which required patients to convert to NSR in order to be discharged [15,[17][18]20,[25][26][27][28][29][30] . While conversion to NSR seems desirable, particularly in patients with acute onset of AF/AFL, there is no particular reason that persistence of AF/AFL should preclude ED discharge, provided that rate control is adequate and the patient is otherwise stable and not severely symptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…successful conversion rates, respectively [22,23] .The use of IV ibutilide resulted in conversion rates ranging from 64% to 76% [24,25,26,28] . IV procainamide was used by Stiell et al and White et al with a 50% and 67% success rate, respectively [27,30] . Hirschl et al compared a variety of different medications, and found that flecainide (95%) and ibutilide (76%) had the highest rates of conversion to NSR [28] .…”

Section: Electrical Cardioversion-based Protocolsmentioning

confidence: 99%

“…Ten of the articles dealt with medical management of AF in the ED, either with chemical cardioversion or rate control alone [Table 3] [21][22][23][24][25][26][27][28][29][30] . Chemical cardioversion had varying success rates depending on the pharmacologic agent that was chosen.…”

Section: Antiarrhythmic-based Protocolsmentioning

confidence: 99%

See 2 more Smart Citations

Management and Disposition of Atrial Fibrillation in the Emergency Department: A Systematic Review

Vandermolen

Sadaf

Gehi

2018

Journal of Atrial Fibrillation

View full text Add to dashboard Cite

Introduction: Management of atrial fibrillation (AF) and atrial flutter (AFL) in the emergency department (ED) varies greatly, and there are currently no United States guidelines to guide management with regard to patient disposition after ED treatment. The aim of this systematic review was to evaluate the literature for decision aids to guide disposition of patients with AF/AFLin the ED, and assess potential outcomes associated with different management strategies in the ED.Methods and Results: A systematic review was done using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE, combining the search terms "Atrial Fibrillation", "Atrial Flutter", "Emergency Medicine", "Emergency Service", and "Emergency Treatment". After removal of duplicates, 754 articles were identified. After initial screening of titles and abstracts, 69full text articles were carefully reviewed and 34 articles were ultimately included in the study based on inclusion and exclusion criteria. The articles were grouped into four main categories: decision aids and outcome predictors, electrical cardioversion-based protocols, antiarrhythmic-based protocols, and general management protocols.Conclusion: This systematic review is the first study to our knowledge to evaluate the optimal management of symptomatic AF/AFLin the ED with a direct impact on ED disposition. There are several viable management strategies that can result in safe discharge from the ED in the right patient population, and decision aids can be utilized to guide selection of appropriate patients for discharge.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Electrical Cardioversion-based Protocolsmentioning

confidence: 99%

See 1 more Smart Citation

Management and Disposition of Atrial Fibrillation in the Emergency Department: A Systematic Review

Vandermolen

Sadaf

Gehi

2018

Journal of Atrial Fibrillation

View full text Add to dashboard Cite

show abstract

“…[24] AF is often first diagnosed in the ED setting and many patients ultimately diagnosed with AF are frequently seen in the ED for AF-related complaints. [12, 13] Our review of 296 patients diagnosed with new AF in the ED over a 3 year-period found nearly half of these patients were seen in the ED prior to the AF diagnosis. The ED presents an opportunity to potentially identify patients at high risk for developing AF and direct these individuals to appropriate interventions that might delay or prevent the onset of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…[12, 13] AF-related complaints include signs (tachycardia, dyspnea) or symptoms (palpitations, chest pain, shortness of breath, weakness, lightheadedness, pre-syncope, or syncope) consistent with symptomatic AF. [12, 13] Pulse measurements and electrocardiograms, both of which are performed regularly in the ED, also diagnose new AF in otherwise asymptomatic individuals. [14, 15] This study's objective was to describe the frequencies of these risk factors and calculate the corresponding risk score in a cohort of ED patients with newly diagnosed AF.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Framingham risk factors among ED patients with newly diagnosed atrial fibrillation

Barrett

Storrow

Jenkins

et al. 2012

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

Study Objective Atrial fibrillation (AF) is often first diagnosed in the emergency department (ED) and accounts for nearly 1% of all ED visits. Our objective was to assess the Framingham Heart Study risk score for AF development in ED patients with newly diagnosed AF. Methods We systematically reviewed the electronic medical records of ED patients with newly diagnosed AF between August 2005 and July 2008. We measured the frequency of the Framingham Heart Study predictors and calculated each patient's risk score. Results During the 3-year study period, 914 patients had 1228 ED visits. New AF was diagnosed in 296 (32%) patients. Among these patients, 107 (36%) were female, 127 (43%) had prior ED visits since 2003, 189 (64%) were taking hypertension medications and 170 (57.4%) had previous electrocardiograms with measurable PR intervals. The median PR interval was 166 ms (151 to 180) and 60% of available PR intervals were ≥160 ms. The median (Interquartile range) age, body mass index, and systolic blood pressure were 66 years (53 to 77), 27 (23 to 31), and 134 mm Hg (118 to 151), respectively. Median risk score was 7 (3 to 9) indicating high predicted risk. Heart failure and cardiac murmurs were previously diagnosed in 45 (15%) and 32 (11%) of these patients, respectively. Conclusions The Framingham risk factors for AF are commonly encountered among ED patients with newly diagnosed AF. The ED might provide an opportunity to identify patients at high risk for AF and refer them for primary prevention interventions.

show abstract

Pharmacologic Management of Atrial Fibrillation and Flutter

Saluja¹,

Hickey²,

Reiffel³

2010

Management of Cardiac Arrhythmias

View full text Add to dashboard Cite

Emergency Department Use of Intravenous Procainamide for Patients with Acute Atrial Fibrillation or Flutter

Abstract: This study of acute atrial fibrillation or flutter patients treated in the ED with IV procainamide suggests that this treatment is safe and effective in this setting. Procainamide should be prospectively compared with other ED strategies.

Cited by 53 publications

References 32 publications

Management and Disposition of Atrial Fibrillation in the Emergency Department: A Systematic Review

Management and Disposition of Atrial Fibrillation in the Emergency Department: A Systematic Review

Assessment of the Framingham risk factors among ED patients with newly diagnosed atrial fibrillation

Pharmacologic Management of Atrial Fibrillation and Flutter

Contact Info

Product

Resources

About