OBJECTIVE: To explore the safety and effectiveness of electric cardioversion to treat atrial fibrillation in a hospital emergency department (ED).
METHODS: Retrospective observational study in a hospital ED. We reviewed episodes of atrial fibrillation in patients aged 18 years orolder treated with cardioversion in our ED or referred for scheduling of cardioversion. Clinical outcome measures were conversion to sinus rhythm, immediate adverse effects (hypotension, arrythmia, or bronchial aspiration), revisiting within 90 days for atrial fibrillation, and complications (stroke, major bleeding, heart failure, or death). We studied factors associated with recurrence and adverse effects according to sex.
RESULTS: Cardioversion was used in 365 episodes (median patient age, 67 years); 38.6% were women. Cardioversion was applied in the ED in 75.1% of the episodes, and 24.9% were referred for scheduled cardioversion. Sinus rhythm was restored in 90.7% of the episodes. Emergency cardioversion was more effective than a scheduled procedure (odds ratio [OR], 4.258; 95% CI, 2.046-8.859; P < .001). No serious immediate adverse effects were reported, but 16.7% of the patients revisited for atrial fibrillation within 90 days. Factors associated with revisits were heart failure (hazard ratio [HR], 2.603; 95% CI, 1.298-5.222; P = .007), sleep apnea (HR, 2.598; 95% CI, 1.163-5.803; P = .020), and, in women, hypertension (HR, 3.706; 95% CI, 1.051-13.068; P = .042). Eleven patients developed late adverse events, including stroke (n = 2), major bleeding (n = 1), heart failure (n = 5), and death (n = 3).
CONCLUSIONS: Cardioversion is a useful, effective, and safe treatment for atrial fibrillation in the ED, although there are frequent recurrences. Factors associated with recurrence differ according to sex.
OBJECTIVE: Conocer la seguridad y eficacia de la cardioversión eléctrica (CVE) en la fibrilación auricular (FA) en un servicio de urgencias hospitalario (SUH).
METHODS: Estudio observacional y retrospectivo realizado en un SUH. Se revisaron los episodios de FA en pacientes con edad igual o mayor a 18 años a los que se les realizó CVE en el SUH o se les programó de forma diferida. Las variables resultado fueron: reversión a ritmo sinusal (RS), efectos adversos inmediatos (hipotensión, arritmia y broncoaspiración), reconsulta a 90 días por FA y desarrollo de complicaciones (ictus, hemorragia mayor, insuficiencia cardiaca y mortalidad). Se estudiaron los factores asociados a recurrencia y efectos adversos, y se analizaron las diferencias por sexo.
RESULTS: Se incluyeron 365 episodios de CVE (67 años; 38,6% mujeres); el 75,1% se realizó en el SUH y el 24,9% se derivaron para CVE diferida. El 90,7% revirtieron a RS. La CVE urgente fue más efectiva que la diferida (OR 4,258; IC 95% 2,046-8,859; p < 0,001). No hubo efectos adversos inmediatos graves. El 16,7% de pacientes reconsultaron por FA en los 90 días posteriores. Los factores asociados a reconsulta fueron insuficiencia cardiaca (HR 2,603; IC 95% 1,298-5,222; p = 0,007), apnea del sueño (HR 2,598; IC 95% 1,163-5,803; p = 0,020) y, en mujeres, hipertensión arterial (HR 3,706;IC 95% 1,051-13,068; p = 0,042). Tras la CVE, 11 pacientes presentaron eventos adversos tardíos que incluyeron ictus (n = 2), hemorragia mayor (n = 1), insuficiencia cardiaca (n = 5) y muerte (n = 3).
CONCLUSIONS: La CVE es útil, eficaz y segura para la FA en los SUH, aunque las recurrencias son frecuentes. Los factores asociados a recurrencia difieren entre sexos.