G. Cellarier et al., Hospital management of atrial fibrillation: Epidemiological data and therapeutic strategy in 100 consecutive patients., ARCH MAL C, 93(7), 2000, pp. 821-826
Despite recent large scale trials, the management of atrial fibrillation re
mains very variable. The authors report the results of a prospective study
of the management of atrial fibrillation in their department.
One hundred consecutive patients admitted for atrial fibrillation were incl
uded in the study. The epidemiological and clinical data and the results of
the therapeutic strategy were recorded prospectively.
Three embolic complications occurred before hospital admission. The hospita
l stay was marked by spontaneous reduction of atrial fibrillation in 14 cas
es in the 6 hours following admission. The therapeutic strategy was the fol
lowing : 40 arrhythmias were respected (well tolerated, > 1 year or with a
left atrium 60 mm). Oral amiodarone (30 mg/Kg and 15 mg/Kg the next day) wa
s given to 22 patients. Only 9 patients (41%) were converted (average delay
of 12 hours). Four patients received intravenous amiodarone, reducing two
arrhythmias. Twenty patients were treated by external electrical cardiovers
ion of first intent and 14 after failure of pharmacological reduction. All
of these procedures, early (after 48 hours anticoagulation and transoesopha
geal echocardiography), or late (after 1 month of anticoagulation), restore
d sinus rhythm without complications, especially embolic.
This register showed a relatively low efficacy of oral amiodarone in the re
duction of atrial fibrillation and underlines the efficacy and safety of ex
ternal electrical cardioversion, even when performed early.