Adverse Events Associated With Electrical Cardioversion in Patients With Acute Atrial Fibrillation and Atrial Flutter.

Abstract

BACKGROUND:

We sought to evaluate safety of electrical cardioversion (ECV) for patients with acute atrial fibrillation (AF) or atrial flutter (AFL) in the emergency department (ED).

METHODS:

This was an analysis of data from 4 multicentre AF/AFL studies conducted from 2008 to 2019 at 23 large EDs. We included adult patients who received attempts at ECV and who had presented acutely after symptom onset. Staff manually reviewed study and clinical records to abstract data.

RESULTS:

We evaluated 1736 ECV cases with a mean age of 60.1 years and 67.1% male. The overall success of ECV was 90.2% (95% confidence interval 88.7%-91.6%), with 4.9% of patients admitted. ED physicians performed the ECV in 95.2% and provided sedation in 96.5%; 13.9% (12.3%-15.7%) of cases experienced important adverse events that required treatment, and 0.4% were classified as life threatening. Another 5.6% had adverse events that did not require treatment. Logistic regression found that the RAFF-3 study cohort (odds ratio [OR] 2.0), age ≥ 85 years (OR 2.1), coronary artery disease (OR 1.5), midazolam (OR 1.9), and fentanyl (OR 1.5) were associated with important adverse events.

CONCLUSIONS:

This large evaluation of the safety of ECV for acute AF/AFL in the ED found that while serious adverse events were rare, there were a concerning number of events following sedation that required intervention. Physicians should be aware that older age, coronary artery disease, and fentanyl are associated with higher risks of important adverse events. This study provides more information for shared decision making discussions with patients when choosing between drug-shock and shock-only cardioversion strategies.

• Authors: Ian G Stiell, Debra Eagles, Marie-Joe Nemnom, Erica Brown, Monica Taljaard, RAFF Investigators, Patrick M Archambault, David Birnie, Bjug Borgundvaag, Gregory Clark, Philip Davis, Danny Godin, Corinne M Hohl, Bernard Mathieu, Andrew D McRae, Eric Mercier, Judy Morris, Ratika Parkash, Jeffrey J Perry, Brian H Rowe, Venkatesh Thiruganasambandamoorthy, Frank Scheuermeyer, Marco L A Sivilotti, Alain Vadeboncoeur
• Journal: The Canadian journal of cardiology (Can J Cardiol) Vol. 37 Issue 11 Pg. 1775-1782 (11 2021) ISSN: 1916-7075 [Electronic] England
• PMID: 34474123 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Topics

• Acute Disease
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Atrial Fibrillation (therapy)
• Atrial Flutter (therapy)
• Decision Making, Shared
• Electric Countershock (adverse effects)
• Emergency Service, Hospital (statistics & numerical data)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Time Factors
• Treatment Outcome
• Young Adult