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

Abstract

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

An International View of How Recent‐onset Atrial Fibrillation Is Treated in the Emergency Department

“…Other Canadian and Australian studies have also evaluated aggressive management of RAF in the ED. 12,[20][21][22] This study exposes RAF as a dysrhythmia in need of high-quality evidence to guide various aspects of ED management. The large AFFIRM trial (Atrial Fibrillation Follow-up Investigation of Rhythm Management) compared rate versus rhythm control and dealt with various presentations of atrial fibrillation and included very few patients with RAF.…”

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

“…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.…”

“…[14][15][16][17][18][19][20] Early rhythm control has the advantage of faster outcomes, improved symptom control and reduced hospital stay. 30,31 Furthermore, the longer a patient has AF, the more difficult it is to achieve successful cardioversion to sinus rhythm.…”

Do injection drug users have more adverse events during procedural sedation and analgesia for incision and drainage of cutaneous abscesses?

“…A previous similar audit of ''procedural sedation'' and ''electrical cardioversion'' demonstrated a physician coding accuracy of 99%. 12 At both ED sites, each PSA was performed by the attending emergency physician. As per regional policy, physicians were assisted by registered nurses and respiratory therapists who were specially trained in ED PSA, and cardiac, noninvasive blood pressure, and pulse oximetry monitoring was mandatory.…”