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

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 durin...

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Veröffentlicht in:Cardiology 2009-01, Vol.112 (4), p.270-278
Hauptverfasser: Dankner, Rachel, Shahar, Amir, Novikov, Ilya, Agmon, Uri, Ziv, Arnona, Hod, Hanoch
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container_end_page 278
container_issue 4
container_start_page 270
container_title Cardiology
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creator Dankner, Rachel
Shahar, Amir
Novikov, Ilya
Agmon, Uri
Ziv, Arnona
Hod, Hanoch
description 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.
doi_str_mv 10.1159/000151703
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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 &lt; 0.001), with corresponding percentages of patients discharged from ED (52.9, 47.9 and 32.1%, p &lt; 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.</description><identifier>ISSN: 0008-6312</identifier><identifier>EISSN: 1421-9751</identifier><identifier>DOI: 10.1159/000151703</identifier><identifier>PMID: 18815445</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Aged ; Anti-Arrhythmia Agents - therapeutic use ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - therapy ; Cardiac arrhythmia ; Comparative studies ; Electric Countershock ; Emergency medical care ; Emergency Service, Hospital ; Female ; Hospital Departments ; Humans ; Male ; Medical treatment ; Middle Aged ; Odds Ratio ; Original Research ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Cardiology, 2009-01, Vol.112 (4), p.270-278</ispartof><rights>2008 S. Karger AG, Basel</rights><rights>Copyright 2008 S. Karger AG, Basel.</rights><rights>Copyright (c) 2009 S. Karger AG, Basel</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c331t-75625890bd5e5bb51dc9f596759065aab53f7a89c4a0e9559202da4db3fa335f3</citedby><cites>FETCH-LOGICAL-c331t-75625890bd5e5bb51dc9f596759065aab53f7a89c4a0e9559202da4db3fa335f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,2429,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18815445$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dankner, Rachel</creatorcontrib><creatorcontrib>Shahar, Amir</creatorcontrib><creatorcontrib>Novikov, Ilya</creatorcontrib><creatorcontrib>Agmon, Uri</creatorcontrib><creatorcontrib>Ziv, Arnona</creatorcontrib><creatorcontrib>Hod, Hanoch</creatorcontrib><title>Treatment of Stable Atrial Fibrillation in the Emergency Department: A Population-Based Comparison of Electrical Direct-Current versus Pharmacological Cardioversion or Conservative Management</title><title>Cardiology</title><addtitle>Cardiology</addtitle><description>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 &lt; 0.001), with corresponding percentages of patients discharged from ED (52.9, 47.9 and 32.1%, p &lt; 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%. 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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.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>18815445</pmid><doi>10.1159/000151703</doi><tpages>9</tpages></addata></record>
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subjects Aged
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy
Atrial Fibrillation - therapy
Cardiac arrhythmia
Comparative studies
Electric Countershock
Emergency medical care
Emergency Service, Hospital
Female
Hospital Departments
Humans
Male
Medical treatment
Middle Aged
Odds Ratio
Original Research
Retrospective Studies
Treatment Outcome
title Treatment of Stable Atrial Fibrillation in the Emergency Department: A Population-Based Comparison of Electrical Direct-Current versus Pharmacological Cardioversion or Conservative Management
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