Numerous emergency department (ED) atrial fibrillation (AF) protocols have been developed
to reduce hospitalizations, focusing on the use of cardioversion in the ED. An alternative
strategy of rate control with early specialty follow-up may be more widely applicable.
The likelihood of spontaneous cardioversion with such a protocol is unknown. Between
2015 and 2018, 157 patients who presented to the ED with a primary diagnosis of AF
and were hemodynamically stable and with low to moderate symptom severity were discharged
with early follow-up at an AF specialty clinic. Rhythm at short-term (within 72 hours),
within 30-day follow-up, and need for electrical cardioversion was tabulated. Various
demographic and co-morbidity variables were assessed to determine their association
with likelihood of spontaneous cardioversion. At an average of 2.3 days, 63% and within
30 days, 83% had spontaneous cardioversion. By 90 days, only 6.3% required electrical
cardioversion. Diabetes (38% vs 69%, p <0.01), coronary artery disease (39% vs 66%,
p = 0.02), reduced ejection fraction (40% vs 72%, p <0.01), dilated right atrium (43%
vs 73%, p <0.01) and moderate-to-severely dilated left atrium (38% vs 78%, p <0.01)
predicted those who were less likely to convert to sinus rhythm. Most patients who
present to the ED with AF will spontaneously convert to sinus rhythm by short-term
(2 to 3 days) follow-up with a rate control strategy. In conclusion, aggressive use
of electrical cardioversion in the ED may be unnecessary in hemodynamically stable
patients without severe symptoms.
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Article Info
Publication History
Published online: August 23, 2019
Received in revised form:
August 6,
2019
Received:
May 12,
2019
Footnotes
Funding: Funding for this project was provided by the 2015 Innovation Pilot Award, University of North Carolina Center for Health Innovation, The North Carolina Translational and Clinical Sciences Institute and the Bristol-Myers Squib Foundation.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
