Acute Afib: electrical-first cardioversion speeds disposition

  • Scheuermeyer FX & al.
  • Acad Emerg Med
  • 19 Aug 2019

  • International Clinical Digest
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Takeaway

  • In this trial comparing 2 rhythm control methods for emergency department (ED) patients with acute, short-duration Afib, both chemical and electrical rhythm control were effective, but the latter was faster.

Why this matters

  • Both chemical-first and electrical-first strategies are considered safe, but few studies address their comparative effectiveness.

Key results

  • All patients but 1 successfully cardioverted; all were discharged home.
  • Chemical- vs electrical-first group:
    • Proportion discharged within 4 hours: 32% (13/41) vs 67% (29/43) (95% CI, 16%-56%; P<.001>
    • Median ED length of stay: 5.1 vs 3.5 hours; difference, 1.2 hours (95% CI, 0.4-2.0 hours; P<.001>
    • Median time from randomisation to conversion: 2.3 vs 0.6 hours; difference, 1.4 (95% CI, 0.8-1.9) hours. 

Study design

  • 6-centre randomised study (n=84).
  • Adults aged ≤75 years presenting to ED with low-risk, uncomplicated, symptomatic Afib of
  • All had CHADS2 score of ≤1.
  • Outcome: proportion discharged within 4 hours of arrival.
  • Funding: None.

Limitations

  • Nonblinded.
  • May not generalise to older, sicker, or chronic Afib populations.
  • ED lengths of stay likely influenced by multiple unrelated factors.
  • Over one-third of patients declined to enroll, potentially skewing population toward patients with new Afib.