EBQ:48hr Cardioversion for Afib: Difference between revisions
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*Two Centers: | *Two Centers: | ||
**Beth Israel Deaconess Hospital - Boston, Massachusetts (Jan. 1, 1990 - Sept. 25, 1995) | **Beth Israel Deaconess Hospital - Boston, Massachusetts (Jan. 1, 1990 - Sept. 25, 1995) | ||
**Univ. Connecticut Health Center | **Univ. Connecticut Health Center - Farmington, Connecticut (Sept. 28, 1991 - April 29, 1996) | ||
*N=375 | *N=375 | ||
*Duration: | *Duration: |
Revision as of 15:36, 1 April 2014
PubMed Full text PDF
Clinical Question
For patients presenting with Atrial Fibrillation lasting less than 48 hours, what is the incidence of cardioversion-related thromboembolism?
Conclusion
*Among patients with Atrial Fibrillation clinically estimated to be <48 hours, the likelihood of cardioversion-related clinical thromboembolism is very low
- This data support early cardioversion in these patients
Major Points
Cardioversion of atrial fibrillation is necessary toimprove cardiac function, relieve symptoms and decrease the rate of thrombus formation.[1]. With many patients presenting acutely for new onset atrial fibrillation within 48hrs, this study assessed the risk of thromboembolic event following cardiovrsion or spontaneous conversion after rate control. Of the 357 patients converted to sinus rhythm within the first 48hrs only 3 patients (0.8%) experienced a thromboembolic event. An editional review of 5 studies on the saftey of ED cardioversion suggest that the major complication occuring from ED cardioversion relates to the procedural sedation with rare complications from the cardioversion event.[2] The EBQ:Ottowa Aggressive ED Cardioversion Protocol demonstrates the saftey and effectiveness of ED cardioversion of new onset Atrial Fib within 48hrs if appropriate followup exists for patients.
Study Design
- Prospective cohort study
- Two Centers:
- Beth Israel Deaconess Hospital - Boston, Massachusetts (Jan. 1, 1990 - Sept. 25, 1995)
- Univ. Connecticut Health Center - Farmington, Connecticut (Sept. 28, 1991 - April 29, 1996)
- N=375
- Duration:
- Primary Outcome: incidence of cardioversion related clinical thromboembolism
Population
Patient Demographics
- 214 Women, 161 Men
- Mean age: 68 years
- Predisposing factors to Atrial Fib:
- Hypertension: 41.7%
- Active Infection: 6.7%
- Alcohol Intake: 5.9%
- Rheumatic Heart Disease: 1.9%
- Other 1.9
- Comorbidities:
- Prio A. Fib: 48.3%
- CAD: 30.4%
- No underlying disorders: 24.3%
- MI: 10.4%
- Prior Thromboembolism: 6.1%
Inclusion Criteria
- Atrial Fibrillation < 48hrs
- onset estimated on basis of: palpitations, dyspnea, angina, & dizziness
Exclusion Criteria
- Inability to identify duration of atrial fibrillation
- Atrial Fibrillation > 48hrs
- Presentation witih an acute thromboembolism
- On long term warfarin
- Prothrombin time >1.6 times normal
Interventions
Outcome
Primary Outcomes
Secondary Outcomes
- Conversion rates to sinus rhythm:
- 95.2% total conversion
- 66.7% spontaneous conversion
- 28.5% active cardioversion
Subgroup analysis
Criticisms & Further Discussion
Additional Resources
[ERCast Podcast-Cardioversion]