title: Management of new onset atrial fibrillation in previously well patients less than 60 years of age.
abstract: OBJECTIVE
  This study reviewed the ED management of new onset atrial fibrillation (AF) in previously well patients aged less than 60 years.
  
  
  METHODS
  We undertook a retrospective review of ED patients from 1998 to 2002 inclusive. The main outcome measures were approaches to rate or rhythm control and anticoagulation, the use of echocardiography, the value of diagnostic testing and the frequency of hospital admission.
  
  
  RESULTS
  Fifty-two patients were identified. In general, all patients were haemodynamically stable. One patient had mild cardiac failure and one was clinically thyrotoxic. Serum potassium was measured in 51 (98%) patients, magnesium in 23 (44%) and cardiac enzymes in 30 (58%); results were generally unhelpful. Thyroid function tests were carried out in 40 (77%) patients; results were unremarkable except for the clinically thyrotoxic patient. No patient had echocardiography in the ED; however, 6 patients (12%) were later found to have major cardiac abnormalities. Forty-four (85%) patients received a variety of medications; 37 (71%) received an anti-arrhythmic and 24 (46%) an antithrombotic. Overall, 17 (33%) patients received theoretically effective therapy for conversion to sinus rhythm. Twenty-two (42%) patients were admitted to hospital.
  
  
  CONCLUSIONS
  This study reveals variation in the management of acute AF in previously well, haemodynamically stable, young patients. Pathology testing was frequently carried out with a low yield. There were high rates of attempts to cardiovert, use of antithrombotics and of admission to hospital. Although cardioversion attempts appeared to be contrary to existing guidelines, decisions may have been based primarily on patient symptoms. Echocardiography should be considered prior to anti-arrhythmic therapy.
authors.affiliation: Emergency Department, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia. david.taylor@mh.org.au
authors.forename: David McD
authors.initials: DM
authors.lastname: Taylor
authors.forename: Anuradha
authors.initials: A
authors.lastname: Aggarwal
authors.forename: Michael
authors.initials: M
authors.lastname: Carter
authors.forename: Devinder
authors.initials: D
authors.lastname: Garewal
authors.forename: David
authors.initials: D
authors.lastname: Hunt
mesh_terms: D000328:Adult; D017668:Age of Onset; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D004452:Echocardiography; D004554:Electric Countershock / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants