Safety and efficacy of pharmacological cardioversion of recent-onset atrial fibrillation: a single-center experience.

Abstract

BACKGROUND AND AIM:

The management of patients with recent-onset atrial fibrillation (AF) presenting at emergency departments (EDs) varies widely. Our aim was to describe the management of patients with recent-onset (<48 hours) AF, to determine safety and efficacy of pharmacological cardioversion at the ED, and to evaluate the incidence of thromboembolism or death at 30 days.

METHODS:

In a prospective, observational, single-center study, 236 subjects with recent-onset AF were consecutively enrolled from January 2011 until January 2013. Follow-up information was obtained by reviewing all available clinical records.

RESULTS:

As first-line therapy, 45.3% (n = 107) received ibutilide, 28.8% (n = 68) vernakalant, 25% (n = 59) flecainide, and 0.8% (n = 2) amiodarone, respectively. Successful cardioversion was achieved in 72.5% (n = 171) of patients after first-line therapy. There was no significant difference between treatment groups. In univariable logistic regression analysis, age (odds ratio [OR] = 1.027; 95% confidence interval [CI], 1.003-1.052; P= .03), duration of symptoms (OR = 0.968; 95% CI, 0.938-0.999; P= .045), as well as the CHA2DS2-VASc score (1 point for Congestive heart failure, Hypertension, Age between 65 and 74 years, Diabetes, Vascular disease, Sex category if female and 2 points for previous TIA/Stroke and Age ≥ 75 years) (OR = 1.237; 95% CI, 1.01-1.515; P= .04) were associated with success of pharmacological cardioversion. Within 30 days, 1 patient suffered from fatal ischemic stroke.

CONCLUSION:

Pharmacological cardioversion followed by discharge after a short observation period is safe. There was no significant difference between the agents used in terms of short-term safety and efficacy. Importantly, the coherence of the ED to recent guidelines regarding first-line therapy is high.

• Authors: R Kriz, M K Freynhofer, T W Weiss, F Egger, S C Gruber, P Eisenburger, J Wojta, K Huber, J Koch
• Journal: The American journal of emergency medicine (Am J Emerg Med) Vol. 34 Issue 8 Pg. 1486-90 (Aug 2016) ISSN: 1532-8171 [Electronic] United States
• PMID: 27292602 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Arrhythmia Agents

Topics

• Aged
• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (drug therapy, physiopathology)
• Electrocardiography
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Treatment Outcome