Management of new-onset atrial fibrillation in the emergency department: is there any predictive factor for early successful cardioversion?
OBJECTIVE
The aim of this retrospective study was to assess the initial management of atrial fibrillation (AF) in the emergency department (ED) and to identify predictive factors of early conversion to sinus rhythm, which could justify a short stay in the ED observation unit (EDOU) instead of longer hospitalization.


METHODS
All patients with acute AF, either of new onset or recurrent, admitted to our hospital during a 12-month period were included in the study. Hospital records were reviewed retrospectively. The success of conversion to sinus rhythm was recorded in association with a series of clinical and laboratory factors.


RESULTS
Sixty-seven patients (39 men and 28 women), with a mean age of 63.6+/-12.2 years, were studied. The most frequent presenting symptom was palpitations (n=40, 59.7%). In forty-two patients (62.7%) the duration of symptoms was less than 48 h. Digoxine was the anti-arrhythmic agent most frequently administered (n=26, 38.8%), followed by amiodarone (n=17, 25.4%). Fifty patients (73.1%) converted to sinus rhythm and for 45 of them conversion took place during their stay in the ED or in the EDOU. Factors associated with early conversion to sinus rhythm were aged younger than 65 years (P=0.021) and symptom duration of less than 48 h (P=0.001). On the other hand, the presence of signs of heart failure was significantly associated with unsuccessful early cardioversion (P=0.001).


CONCLUSIONS
The majority of patients admitted with AF of acute onset had early conversion to sinus rhythm. AF in young patients, with a duration of symptoms of less than 48 h and without signs of heart failure can be managed in the EDOU, thus avoiding a longer hospitalization.
Zahir
Soheil
S
Department of Emergency Medicine, Erasme University Hospital, Brussels, Belgium. soheil.zahir@ulb.ac.be
Lheureux
Philippe
P
D000367:Age Factors; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D001530:Belgium; D004417:Dyspnea / Q000209:etiology; D004554:Electric Countershock / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000379:methods* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome