Annals of Emergency Medicine
Volume 52, Issue 4 , Pages 322-328 , October 2008

A Prospective, Randomized Trial of an Emergency Department Observation Unit for Acute Onset Atrial Fibrillation

  • Wyatt W. Decker, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • Corresponding Author InformationAddress for correspondence: Wyatt W. Decker, MD, Department of Emergency Medicine, Genrose G-410, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; 507-255-6501, fax 507-255-6592
    • ,
  • Peter A. Smars, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Lekshmi Vaidyanathan, MBBS

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Deepi G. Goyal, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Eric T. Boie, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Latha G. Stead, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Douglas L. Packer, MD

      Affiliations

    • Cardiology, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Thomas D. Meloy, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Andy J. Boggust, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Luis H. Haro, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Dennis A. Laudon, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Joseph K. Lobl, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Annie T. Sadosty, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Raquel M. Schears, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Nicola E. Schiebel, MD

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • David O. Hodge, MS

      Affiliations

    • Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Win-Kuang Shen, MD

      Affiliations

    • Cardiology, Mayo Clinic College of Medicine, Rochester, MN

Received 21 May 2007 ,Revised 1 November 2007 ,Accepted 12 December 2007.

References 

  1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370–2375
  2. Friberg J, Buch P, Scharling H, et al. Rising rates of hospital admissions for atrial fibrillation. Epidemiology. 2003;14:666–672
  3. Arias E. United States Life Tables, 2002 (National Vital Statistics Reports; Vol. 53 No: 6). Hyattsville, MD: National Center for Health Statistics; 2004;
  4. Coyne KS, Paramore C, Grandy S, et al. Assessing the direct costs of treating nonvalvular atrial fibrillation in the United States. Value Health. 2006;9:348–356
  5. Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias: executive summary; a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation. 2003;108:1871–1909
  6. Lip GY, Watson T, Shantsila E. Anticoagulation for stroke prevention in atrial fibrillation: is gender important?. Eur Heart J. 2006;27:1893–1894
  7. Benjamin EJ, Wolf PA, D'Agostino RB, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98:946–952
  8. Koenig BO, Ross MA, Jackson RE. An emergency department observation unit protocol for acute onset atrial fibrillation is feasible. Ann Emerg Med. 2002;39:374–381
  9. Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e257–e354
  10. Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Eng J Med. 2002;347:1834–1840
  11. Rienstra M, Van Veldhuisen DJ, Hagens VE, et al. RACE Investigators Gender-related differences in rhythm control treatment in persistent atrial fibrillation: data of the RACE study. J Am Coll Cardiol. 2005;46:1307–1308
  12. Roberts R, Graff LG. Economic issues in observation unit medicine. Emerg Med Clin North Am. 2001;19:19–33
  13. Farkouh ME, Smars PA, Reeder GS, et al. A clinical trial of a chest-pain observation unit for patients with unstable angina. N Engl J Med. 1998;339:1882–1888
  14. Rydman RJ, Isola ML, Roberts RR, et al. Emergency department observation unit versus hospital inpatient care for a chronic asthmatic population: a randomized trial of health status outcome and cost. Med Care. 1998;36:599–609
  15. Smars PA, Decker WW, Shen WK. Syncope evaluation in the emergency department. Curr Opin Cardiol. 2007;22:44–48
  16. Raghavan AV, Decker WW, Meloy TD. Management of atrial fibrillation in the emergency department. Emerg Med Clin North Am. 2005;23:1127–1139
  17. The AFFIRM Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;34:1825–1833
  18. Stead LG, Decker WW. Rhythm versus rate control for atrial fibrillation and flutter. Ann Emerg Med. 2006;47:496–498
  19. Steinberg JS, Sadaniantz A, Kron J, et al. Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study. Circulation. 2004;109:1973–1980
  20. Zahir S, Lheureux P. Management of new-onset atrial fibrillation in the emergency department: is there any predictive factor for early successful cardioversion?. Eur J Emerg Med. 2005;12:52–56
  21. Domanovits H, Schillinger M, Thoennissen J, et al. Termination of recent-onset atrial fibrillation/flutter in the emergency department: a sequential approach with intravenous ibutilide and external electrical cardioversion. Resuscitation. 2000;45:181–187
  22. Michael JA, Stiell IG, Agarwal S, et al. Cardioversion of paroxysmal atrial fibrillation in the emergency department. Ann Emerg Med. 1999;33:379–387
  23. Burton JH, Vinson DR, Drummond K, et al. Electrical cardioversion of emergency department patients with atrial fibrillation. Ann Emerg Med. 2004;44:20–30
  24. Weigner MJ, Caulfield TA, Danias PG, et al. Risk for clinical thromboembolism associated with conversion to sinus rhythm in patients with atrial fibrillation lasting less than 48 hours. Ann Intern Med. 1997;126:615–620
  25. Crenshaw LA, Lindsell CJ, Storrow AB, et al. An evaluation of emergency physician selection of observation unit patients. Am J Emerg Med. 2006;24:271–279
  26. Rienstra M, Van Gelder IC, Hagens VE, et al. Mending the rhythm does not improve prognosis in patients with persistent atrial fibrillation: a subanalysis of the RACE study. Eur Heart J. 2006;27:357–364
  27. Mulcahy B, Coates WC, Henneman PL, et al. New-onset atrial fibrillation: when is admission medically justified?. Acad Emerg Med. 1996;3:114–119
  28. Greene HL, DiMarco JP, Kudenchuk PJ, et al. Comparison of monophasic and biphasic defibrillating pulse waveforms for transthoracic cardioversion. Am J Cardiol. 1995;75:1135–1139

 Supervising editor: W. Brian Gibler, MD

 Author contributions: WWD, PAS, DGG, ETB, DLP, TDM, AJB, LHH, DAL, JKL, ATS, RMS, NES, and W-KS made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data. DOH was responsible for analysis of the data and statistical support. WWD, PAS, LV, LGS, DLP, DOH, and W-KS were responsible for drafting the article or revising it critically for important intellectual content and final approval of the version to be published. WWD takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This research was funded by a clinical research grant from the Mayo Foundation for Education and Research.

 Publication dates: Available online March 14, 2008.

 Reprints not available from the authors.

PII: S0196-0644(07)01871-9

doi: 10.1016/j.annemergmed.2007.12.015

Annals of Emergency Medicine
Volume 52, Issue 4 , Pages 322-328 , October 2008

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