Evaluation and Management of Atrial Fibrillation in the Emergency Department

Li, Huagui; Easley, Arthur R.; Barrington, William; Windle, John R.

doi:10.1016/s0733-8627(05)70008-0

Cited by 30 publications

(35 citation statements)

References 40 publications

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“…It affects the quality of life and in some instances may be related to reduced life expectancy of patients, depending on accompanying comorbidities [1,2,3]. The incidence of AF increases with age, and the prevalence of permanent AF is 0.02% in persons aged 30–39 years but increases to 3.9% in persons aged 80–89 years [4].…”

Section: Introductionmentioning

confidence: 99%

“…For example, it is desirable to have facilities with emergency external cardiac pacing available whenever DCC is attempted, because sinus asystole may occur after cardioversion [1]. …”

Section: Introductionmentioning

confidence: 99%

“…Compared with DCC, pharmacological cardioversion is simpler but less efficacious, being successful in approximately 50% of ED patients [1] and carrying the risk of arrhythmogenic side effects. However, no sedation or anesthesia backup is required for pharmacological cardioversion.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Stable Atrial Fibrillation in the Emergency Department: A Population-Based Comparison of Electrical Direct-Current versus Pharmacological Cardioversion or Conservative Management

et al. 2008

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Objective: To compare the success rates and short-term complications of three treatment approaches, pharmacological and direct-current cardioversion (DCC), or ‘wait-and-watch’ among stable atrial fibrillation (AF) patients in the emergency department (ED). Methods: All AF-related ED admissions during a 1-year period were retrospectively reviewed, and those meeting criteria of eligibility for immediate cardioversion, based on clinical stability, AF duration and adequacy of anticoagulation, were included. The propensity score approach generalized for the three groups was used to adjust for the observational non-randomized study nature. Results: Among 374 eligible patients, the rate of successful cardioversion was higher in DCC than in pharmacological or wait-and-watch groups (78.2, 59.2 and 37.9% respectively, p < 0.001), with corresponding percentages of patients discharged from ED (52.9, 47.9 and 32.1%, p < 0.01) and respective odds ratios of 6.00, 2.47 and 1, adjusting for seniority of the treating physician, age, gender and patient comorbidities. DCC was 2.43 times more effective than pharmacological treatment in achieving sinus rhythm (95% confidence interval = 1.36–4.33, p = 0.003). Rehospitalization within 14 days due to probable AF-treatment-related complications of home-discharged patients was 3.4%. Conclusions: DCC was found to be the most effective treatment, with few short-term complications following conversion of stable AF patients to sinus rhythm in the ED.

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Section: Introductionmentioning

confidence: 99%

“…For example, it is desirable to have facilities with emergency external cardiac pacing available whenever DCC is attempted, because sinus asystole may occur after cardioversion [1]. …”

Section: Introductionmentioning

confidence: 99%

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Treatment of Stable Atrial Fibrillation in the Emergency Department: A Population-Based Comparison of Electrical Direct-Current versus Pharmacological Cardioversion or Conservative Management

et al. 2008

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“…11 AF has been qualitatively described as the most frequently managed arrhythmia in the ED, although its prevalence in this setting has not been previously reported. 12 Considering the association of AF with increasing age and the frequency of evaluating individuals without other healthcare access, the potential exists to identify substantial numbers of untreated AF patients at risk of ischemic stroke in the ED. The objective of this study was to assess this potential by estimating the prevalence of AF and the degree and type of antithrombotic use in a tertiary ED patient population.…”

mentioning

confidence: 99%

Prevalence of Atrial Fibrillation and Antithrombotic Prophylaxis in Emergency Department Patients

Scott

Pancioli

Davis

et al. 2002

Stroke

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Background and Purpose-The emergency department (ED), as the point of first medical contact for many complaints referable to atrial fibrillation (AF) and a common source of primary care, occupies a unique position to identify AF patients at risk of stroke. This study evaluates that potential by determining the prevalence of AF in an ED population and assessing antithrombotic use in those patients with recurrent AF. Methods-This was a multicenter, retrospective, cross-sectional study of consecutive records of ED patients with AF identified by ECG between January and June 1998. American Heart Association and modified Stroke Prevention in Atrial Fibrillation criteria established high-risk patients and contraindications to anticoagulation, respectively. Results-We identified 866 records with ECG-proven AF in 78 787 patient visits for an estimated prevalence of 1.10% (95% CI, 1.03 to 1.17). We found that 556 records had a prior history of AF; of these, 221 (40%) used warfarin alone, 155 (28%) had antiplatelet therapy alone, 28 (5%) used both, and 152 (27%) had no antithrombotic therapy identified. Sixty-eight patients (12%; 95% CI, 0.10 to 0.15) were warfarin eligible and without antithrombotic therapy. An additional 64 (12%; 95% CI, 0.09 to 0.14) had antiplatelet therapy alone. In warfarin-eligible patients, no differences were identified between the anticoagulated and nonanticoagulated groups on the basis of age, sex, or race. Of patients on warfarin with a measured international normalized ratio, 61% (95% CI, 0.55 to 0.67) were outside the AHA-recommended range of 2.0 to 3.0. Conclusions-AF is a common finding in an ED population. Many are warfarin eligible and untreated or undertreated.Methods to increase anticoagulant use in this at-risk population warrant further investigation.

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“…Conversion of recent onset AF to sinus rhythm with antiarrhythmic drugs reduces the risk of hemodynamic instability, hospitalizations and atrial remodeling seen with persistent AF [3,4].…”

Section: Introductionmentioning

confidence: 99%

Vernakalant: Perception of state of health in patients with a recent-onset atrial fibrillation

et al. 2014

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Evaluation and Management of Atrial Fibrillation in the Emergency Department

Cited by 30 publications

References 40 publications

Treatment of Stable Atrial Fibrillation in the Emergency Department: A Population-Based Comparison of Electrical Direct-Current versus Pharmacological Cardioversion or Conservative Management

Treatment of Stable Atrial Fibrillation in the Emergency Department: A Population-Based Comparison of Electrical Direct-Current versus Pharmacological Cardioversion or Conservative Management

Prevalence of Atrial Fibrillation and Antithrombotic Prophylaxis in Emergency Department Patients

Vernakalant: Perception of state of health in patients with a recent-onset atrial fibrillation

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