Cardioversion of paroxysmal atrial fibrillation in the emergency department

Study objective: Patients presenting to the emergency department with acute atrial fibrillation are traditionally admitted to hospital. The objective of this study was to review the success and safety of ED cardioversion and discharge of patients with acute atrial fibrillation. Methods: This health records survey included a cohort sample of consecutive patients presenting with acute atrial fibrillation to the ED of a universi ty-affiliated tertiary hospital. Patients who were in unstable condition on presentation, who had a complicating cardiac diagnosis, or those with othe r medical or surgical conditions requiring admission were excluded from the study analysis. Patient visit information was entered into a database that included demographics and clinical presentation, investigations, ED therap y, complications, consultations, disposition, and follow up. Patient visits were then categorized into the following groups: no ED intervention, spont aneous resolution, heart rate control, attempted chemical cardioversion, or electrical cardioversion. The data were analyzed using descriptive methods . Results: Of the 289 eligible patients seen during an 18-month period, 62% ( 180) underwent attempted chemical cardioversion with a 50% success rate and 28% (80) had attempted electrical cardioversion with a 89% success rate. N inety-three percent of electrical cardioversions were performed by emergenc y physicians. There was an overall 6% (19) complication rate, 95% of which were regarded as minor. One patient had a complication caused by a rate con trol medication, which necessitated hospital admission. Ninety-seven percen t (280) of the patients were discharged home directly from the ED. Conclusion: Cardioversion and immediate discharge of patients who present t o the ED with acute atrial fibrillation appears to be bath safe and effecti ve. This management approach should be prospectively evaluated in multiple settings.