From Bench to Bedside—Implementing the New ABC Approach for Atrial Fibrillation in an Emergency Department Setting

Gupta, Sophie; Lutnik, Martin; Niederdöckl, Jan; Schnaubelt, Sebastian

doi:10.3390/ijerph19084797

Cited by 2 publications

(2 citation statements)

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“…Due to its high diagnostic accuracy [26,27], TEE is recommended as the imaging procedure of choice to rule out LAAT in AF and AFL, both before pharmacological or electrical cardioversion and before pulmonary vein isolation (PVI) [8,28]. However, in order to be able to offer TEE at any time, the time and personnel resources of specially trained staff are required, which can be a relevant challenge, especially in EDs [16]. Furthermore, as a semi-invasive technique, TEE carries the risk of very rare but potentially serious complications, like oesophageal perforation, and has relative and absolute contraindications, including a history of dysphagia, restricted neck mobility, oesophageal varices, and coagulopathy [9][10][11]29].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, integrating CT into the workflows of EDs for pre-cardioversion assessment could streamline care pathways and optimize resource utilization [16]. By reducing the reliance on TEE or other invasive procedures that may be logistically challenging or timeconsuming in the acute care setting, CT imaging may expedite decision-making processes and facilitate timely interventions in patients with AF who require urgent treatment.…”

Section: Introductionmentioning

confidence: 99%

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Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department

Gupta,

Lutnik,

Cacioppo

et al. 2024

Diagnostics

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Background: Computed tomography (CT) could be a suitable method for acute exclusion of left atrial appendage thrombus (LAAT) prior to cardioversion of atrial fibrillation (AF) and atrial flutter (AFL) at the emergency department. Our aim was to present our experiences with this modality in recent years. Methods: This registry-based observational study was performed at the Department of Emergency Medicine at the Medical University of Vienna, Austria. We studied all consecutive patients with AF and AFL who underwent CT between January 2012 and January 2023 to rule out LAAT before cardioversion to sinus rhythm was attempted. Follow-ups were conducted by telephone and electronic medical records. The main variables of interest were the rate of LAAT and ischemic stroke at follow-up. Results: A total of 234 patients (143 [61%] men; median age 68 years [IQR 57–76], median CHA2DS2-VASc 2 [IQR 1–4]) were analyzed. Follow-up was completed in 216 (92%) patients after a median of 506 (IQR 159–1391) days. LAAT was detected in eight patients (3%). A total of 163 patients (72%) in whom LAAT was excluded by CT were eventually successfully cardioverted to sinus rhythm. No adverse events occurred during their ED stay. All patients received anticoagulation according to the CHA2DS2-VASc risk stratification, and no patient had suffered an ischemic stroke at follow-up, resulting in an incidence risk of ischemic strokes of 0% (95% CI 0.0–1.2%). Conclusion: LAAT was rare in patients admitted to the ED with AF and AFL who underwent cardiac CT prior to attempted cardioversion. At follow-up, no patient had suffered an ischemic stroke. Prospective studies need to show whether this strategy is suitable for the acute treatment of symptomatic AF in the emergency setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department

Gupta,

Lutnik,

Cacioppo

et al. 2024

Diagnostics

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Clinical characteristics and outcomes of patients admitted with atrial fibrillation/atrial flutter to the Emergency Department

Chourasia

Zyśko

2023

Emerg Med Serv

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Aim: To determine the clinical characteristics and outcomes of patients with atrial fibrillation/atrial flutter (AF) admitted to the Emergency Department (ED). Material and methods: Patients with AF at ED admission with cardiac palpitations only, thromboembolic complications, hemorrhagic complications, hemo¬dynamic instability, other non-traumatic diseases, and trauma. Demographics, vitals, comorbidities, ECG, laboratory findings, treatment, and survival were analyzed. Results: There were 247 patients (55.1% women, 44.9% men) admitted to the ED aged 73.8±13.0 . A total of 226 (79.8%) patients were brought to the ED by Emergency Medical Services, and 121 (49%) had palpitations as a reason for admission. The hospitalization rate was 34%. About 60% of patients were on antithrombotic treatment. Among 45 patients with AF discharged home who were not previously treated with anticoagulants, all but three patients without indications for antithrombotic therapy, received a recommendation to be treated with anticoagulants, but only half of them received a prescription. During the follow-up of 1025 (773-1197), days died 67 (27.1%) patients, and 30-day mortality was 5.3%. The lowest mortality was found in patients admitted due to cardiac palpitations. Conclusions:1. The patients with AF admitted to the ED constitute a group of patients with a high hospitalization rate. 2. The reason for the admission to the ED of patients with AF divides this population into subgroups with different outcomes in terms of mortality and hospitalization.3. The patients discharged home who did not have been earlier treated with anticoagulants received suitable recommendations, however, only about half of them received a prescription for an anticoagulant.

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From Bench to Bedside—Implementing the New ABC Approach for Atrial Fibrillation in an Emergency Department Setting

Abstract: Atrial fibrillation (AF) is a globally evolving medical challenge with, currently, 4% prevalence in the European Union’s population [...]

Cited by 2 publications

References 29 publications

Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department

Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department

Clinical characteristics and outcomes of patients admitted with atrial fibrillation/atrial flutter to the Emergency Department

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