Outpatient electrical cardioversion of atrial fibrillation: efficacy, safety and patients' quality of life.
BACKGROUND
Atrial fibrillation (AF) is the most common sustained arrhythmia. To lower costs and to reduce hospitalization electrical cardioversion (CV) is frequently performed in an outpatient setting although data on safety and patient-acceptance are sparse. Aims of this study were to fill this gap by evaluating efficacy, complication rate, quality of life after CV and patient-acceptance of outpatient CV.


METHODS
One-hundred and eleven consecutive patients with persistent AF were included. Patients were under continuous monitoring throughout the procedure and 3 h after. CV was done in deep sedation using rising energies (200->360 J). Quality of life (QoL), late adverse events and patient-acceptance were assessed 4 weeks after CV.


RESULTS
AF could be terminated with a mean of 1.4 shocks in all patients. Acute adverse events could be observed in 3.6%. Late adverse events were noted in 8.2%. Seventy-four percent of the patients felt "good" or "very good" the day of CV. Eighty-nine percent of the patients would undergo a CV again and in case of a further CV 69% of the patients would prefer an outpatient setting. Patients with a lower QoL-classification had longer duration of atrial fibrillation (median 1 vs. 3 months, p<0.05). No other clinical predictor for adverse events or a low QoL-classification could be identified.


CONCLUSIONS
Electrical CV of persistent AF in an outpatient setting is feasible, safe and has a high patient-acceptance.
Siaplaouras
Stephanos
S
Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Kirrberger Strasse, D-66421 Homburg/Saar, Germany. siaplaouras@aol.com
Buob
Axel
A
Heisel
Armin
A
Böhm
Michael
M
Jung
Jens
J
D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000379:methods; D001281:Atrial Fibrillation / Q000628:therapy*; D001294:Attitude to Health; D003365:Costs and Cost Analysis; D004554:Electric Countershock / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D016896:Treatment Outcome