Managing Emergency Department Patients with Recent-onset Atrial Fibrillation

Abstract Background The management of emergency department (ED) patients with presumed recent-onset atrial fibrillation or flutter ≤ 48 h in duration varies widely. Objective and Method We conducted a prospective study across three affiliated community EDs within a large integrated health care delivery system to describe the management of patients with recent-onset atrial fibrillation or flutter, to determine the safety and effectiveness of ED cardioversion, and to measure the incidence of thromboembolism 30 days after discharge. Results We enrolled 206 patients with convenience sampling between June 2005 and November 2007. Mean age was 64.0 ± 14.4 years (range 21–96 years). Patients were grouped for analysis into four categories based on whether cardioversion was 1) spontaneous in the ED (59; 28.6%); 2) attempted with electrical or pharmacological means (115; 56.3%), with success in 110 (95.7%); 3) hoped for during a short stint of home observation (16; 7.8%, 11 of which spontaneously converted to sinus rhythm within 24 h); or 4) contraindicated (16; 7.8%). Of the entire group, 183 (88.8%) patients were discharged home. Adverse events requiring ED interventions were reported in 6 (2.9%; 95% confidence interval [CI] 1.1–6.2%) patients, all of whom recovered. Two (1.0%; 95% CI 0.1–3.5%) patients were found to have an embolic event on 30-day follow-up. Conclusions Our approach to ED patients with presumed recent-onset atrial fibrillation or flutter seems to be safe and effective, with a high rate of cardioversion and discharge to home coupled with a low ED adverse event and 30-day thromboembolic event rate.