Cardioversion of Paroxysmal Atrial Fibrillation in the Emergency Department☆,☆☆,★
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INTRODUCTION
Acute atrial fibrillation is the most common form of paroxysmal supraventricular tachycardia in patients who present to the emergency department.1, 2 The prevalence is .4% in the general population with a 10-fold increase in patients older than 60 years.3, 4 Symptoms of uncontrolled atrial fibrillation vary from palpitations to poor cardiac performance, resulting in worsening of coronary artery disease, congestive heart failure, and possible sudden cardiac death. Sustained atrial fibrillation
MATERIALS AND METHODS
A health records survey was performed of a consecutive cohort sample of ED patients presenting with the primary diagnosis of acute atrial fibrillation. The study was approved by the institutional research ethics committee.
The Ottawa Civic Hospital is a full-service, tertiary care hospital affiliated with the University of Ottawa Faculty of Medicine and has an annual ED census of 60,000 visits. The ED is staffed by certified emergency physicians 24 hours per day. Postgraduate medical trainees
RESULTS
During the 18-month study period, 655 consecutive ED patient visits were identified as having atrial fibrillation as one of their discharge diagnoses (Figure) ; 359 of these visits met exclusion criteria.
A summary of patient visits excluded for medical reasons is presented in Table 1.
Reasons for Exclusion No. (%) Additional cardiac complication 128 (36)
DISCUSSION
This is the largest reported study of patients with acute atrial fibrillation with conversion to normal sinus rhythm in an ED setting and discharged directly home from the ED. Previous studies have used a retrospective review of inpatient charts to identify patients who may not have needed admission.2, 3 As recommended in these studies, emergency physicians in our group used high-risk criteria (instability on arrival, significant congestive heart failure, chest pain suggestive of significant
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Paroxysmal atrial fibrillation
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Cited by (114)
The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation
2020, Canadian Journal of CardiologySafe Cardioversion for Patients With Acute-Onset Atrial Fibrillation and Flutter: Practical Concerns and Considerations
2019, Canadian Journal of CardiologyPeriprocedural Anticoagulation for Cardioversion of Acute Onset Atrial Fibrillation and Flutter: Evidence Base for Current Guidelines
2019, Canadian Journal of Cardiology
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Address for reprints: John A Michael, MD, Department of Emergency Medicine, North Shore Medical Center, 81 Highland Avenue, Salem, MA 01970; 978-741-1200, ext 3500;fax 978-740-4137;E-mail [email protected].
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