Electrical cardioversion of emergency department patients with atrial fibrillation

Burton, John H.; Vinson, David R.; Drummond, Kate; Strout, Tania D.; Thode, Henry C.; McInturff, Jeff J.

doi:10.1016/j.annemergmed.2004.02.016

« Previous Next »Annals of Emergency Medicine
Volume 44, Issue 1 , Pages 20-30, July 2004

Electrical cardioversion of emergency department patients with atrial fibrillation☆☆☆★★★

From the Department of Emergency Medicine, Maine Medical Center, Portland, ME (Burton, Drummond, Strout); the Department of Emergency Medicine, Kaiser Permanente Medical Centers, Sacramento and Roseville, CA (Vinson, McInturff); and the Department of Emergency Medicine, Health Sciences Center, State University of New York at Stony Brook, Stony Brook, NY (Thode). USA

Received 29 October 2003; received in revised form 29 January 2004 and 11 February 2004; accepted 12 February 2004.

Abstract

Study objective

Electrical cardioversion of emergency department (ED) patients with atrial fibrillation has not been well investigated. The objective of this study is to identify the outcomes and complications associated with ED electrical cardioversion of patients with atrial fibrillation.

Methods

This retrospective health records survey investigated a consecutive cohort of ED patients with atrial fibrillation who underwent electrical cardioversion in 4 EDs during a 42-month period. Trained personnel reviewed medical records for demographic characteristics, clinical descriptors, medical interventions, complications, and ED return visits within 7 days. Data were analyzed using descriptive statistics.

Results

The study population consisted of 388 patients (mean age 61 years; range 20 to 93 years). Duration of atrial fibrillation was less than 48 hours in 99% of the cohort. Electrical cardioversion was successful in 332 (86%) patients. Twenty-eight complications were noted in 25 electrical cardioversion encounters: 22 attributed to procedural sedation and analgesia and 6 attributed to electrical cardioversion. Three hundred thirty-three (86%) patients were discharged to home from the ED: 301 after electrical cardioversion success and 32 with electrical cardioversion failure. Thirty-nine patients (10%) returned to the ED within 7 days, 25 of these patients (6% of successful electrical cardioversion patients) returned because of relapse of atrial fibrillation.

Conclusion

In this multicenter cohort, selected ED patients with atrial fibrillation had high rates of electrical cardioversion success, infrequent hospital admission, and few immediate and short-term complications.

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☆ Author contributions: JHB conceived the study. JHB, DRV, TDS, and KD were participants in study design. All authors participated in and were responsible for data retrieval and record query. JHB was responsible for data management for the entire study. Abstract preparation was undertaken by JHB, DRV, KD, and TDS. HCT and JHB performed statistical review and management. JHB, HCT, and DRV were responsible for initial manuscript preparation, with all authors participating in final manuscript editing and submission for publication. JHB takes responsibility for the paper as a whole.

☆☆ Presented at the Society for Academic Emergency Medicine annual meeting, Boston, MA, May 2003.

★ The authors report this study did not receive any outside funding or support.

★★ Reprints not available from the authors.

PII: S0196-0644(04)00179-9

doi:10.1016/j.annemergmed.2004.02.016