Fernández de Simón A, Coll-Vinent B, Martín A, Suero C, Sánchez J, Varona M, Sánchez S, Cancio M, Carbajosa J, Malagón F, Montull E, Del Arco C
Affiliation of the authors
Grupo de Arritmias Cardiacas, de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES). Servicio de Urgencias del Hospital Universitario Virgen del Rocío de Sevilla, Spain. Área de Urgencias. Grup de Recerca “Urgències: processos i patologies”. IDIBAPS. Unitat de Fibrillació Auricular (UFA). Hospital Clínic. Barcelona, Spain. Servicio de Urgencias, Hospital Universitario Severo Ochoa y Universidad Alfonso X. Madrid, Spain. Área de cuidados críticos y urgencias. Hospital de La Axarquía, Málaga, Spain. Servicio de urgencias, Hospital Universitario Virgen de las Nieves, Granada, Spain. Servicio de urgencias. Hospital de Basurto, Bilbao, Spain. Servicio de urgencias. Hospital universitario Río Hortega, Valladolid, Spain. Servicio de Urgencias. Hospital Donostia, San Sebastián, Spain. Servicio de Urgencias. Hospital General Universitario de Alicante, Spain. Servicio de Urgencias, Hospital de Torrejón, Madrid, Spain. Sanofi Spain. Servicio de Urgencias, Hospital Universitario de La Princesa, Madrid, Spain
Fernández de Simón A, Coll-Vinent B, Martín A, Suero C, Sánchez J, Varona M, et al. Cardioversion in recent onset atrial fibrillation. Emergencias. 2019;31:227-33
Summary
Objectives.
To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified.
Methods.
Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm.
Results.
We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238–0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2–13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6–4.3; P<.001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5–4.8; P<.003).
Conclusions.
Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents
