Presented at the Canadian Association of Emergency Physicians’ Annual Conference, Ottawa, ON, Canada, June 7–11, 2008.
Thirty-day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter
Version of Record online: 2 APR 2010
© 2010 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 17, Issue 4, pages 408–415, April 2010
How to Cite
Xavier Scheuermeyer, F., Grafstein, E., Stenstrom, R., Innes, G., Poureslami, I. and Sighary, M. (2010), Thirty-day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter. Academic Emergency Medicine, 17: 408–415. doi: 10.1111/j.1553-2712.2010.00697.x
- Issue online: 2 APR 2010
- Version of Record online: 2 APR 2010
- Received August 5, 2009; revisions received September 15 and September 19, 2009; accepted September 21, 2009.
- atrial fibrillation;
- atrial flutter;
- electric countershock;
- treatment outcome
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 © 2010 by the Society for Academic Emergency Medicine