Cardioversion in recent onset atrial fibrillation
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Amparo Fernández de Simón1, Blanca Coll-Vinent2, Alfonso Martín3
1Grupo de Arritmias Cardiacas, de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES). Servicio de Urgencias del Hospital Universitario Virgen del Rocío de Sevilla, España.
Insights
Restoring sinus rhythm in emergency departments for recent-onset atrial fibrillation (AF) is safe and effective. Replacing amiodarone with electrical cardioversion or class Ic agents can improve patient outcomes and reduce hospital stays.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Pharmacy
Background:
- Atrial fibrillation (AF) is a common arrhythmia requiring prompt management in emergency departments.
- Effective heart rate control and rhythm restoration are crucial for improving patient outcomes in acute AF.
- Current strategies for managing recent-onset AF in emergency settings warrant analysis to identify areas for improvement.
Purpose of the Study:
- To analyze current heart rate control practices and patient outcomes for recent-onset atrial fibrillation (AF) in hospital emergency departments.
- To identify specific interventions and treatments that can optimize the management of AF in the emergency setting.
- To establish benchmarks for improving the quality of care provided to patients with acute AF.
Main Methods:
- A multicenter, prospective, observational, cross-sectional study was conducted.
- Data were collected from 124 Spanish hospitals using the HERMES-AF database between May 23 and June 5, 2011.
- Included were 337 patients with symptomatic AF within 48 hours of onset, managed with the intent to restore sinus rhythm.
Main Results:
- Sinus rhythm was restored in 82.5% of patients, with symptom resolution in 94%.
- Amiodarone use was linked to lower sinus rhythm restoration rates and longer hospital stays.
- Class Ic antiarrhythmic agents were associated with a higher likelihood of discharge within 6 hours.
Conclusions:
- Emergency department management of recent-onset AF, focusing on sinus rhythm restoration, is safe and effective.
- Clinical benefits are associated with successful rhythm control in the emergency setting.
- Replacing amiodarone with electrical cardioversion or class Ic agents may enhance treatment efficacy and efficiency.
Objectives:
To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified.
Material And Methods:
Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm.
Results:
We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238-0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2-13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6-4.3; P< .001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5-4.8; P< .003).
Conclusion:
Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents.
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