A prospective, randomized trial of an emergency department observation unit for acute onset atrial fibrillation.
OBJECTIVE
An emergency department (ED) observation unit protocol for the management of acute onset atrial fibrillation is compared with routine hospital admission and management.


METHODS
Adult patients presenting to the ED with atrial fibrillation of less than 48 hours' duration without hemodynamic instability or other comorbid conditions requiring hospitalization were enrolled. Participants were randomized to either ED observation unit care or routine inpatient care. The ED observation unit protocol included pulse rate control, cardiac monitoring, reassessment, and electrical cardioversion if atrial fibrillation persisted. Patients who reverted to sinus rhythm were discharged with a cardiology follow-up within 3 days, whereas those still in atrial fibrillation were admitted. All cases were followed up for 6 months and adverse events recorded.


RESULTS
Of the 153 patients, 75 were randomized to the ED observation unit and 78 to routine inhospital care. Eighty-five percent of ED observation unit patients converted to sinus rhythm versus 73% in the routine care group (difference 12%; 95% confidence interval [CI] -1% to 25%]; P=.06). The median length of stay was 10.1 versus 25.2 hours (difference 15.1 hours; 95% CI 11.2 to 19.6; P<.001) for ED observation unit and inhospital care respectively. Nine ED observation unit patients required inpatient admission. Eleven percent of the ED observation unit group had recurrence of atrial fibrillation during follow-up versus 10% of the routine inpatient care group (difference 1%; 95% CI -9% to 11%; P=.93). There was no significant difference between the groups in the frequency of hospitalization or the number of tests, and the number of adverse events during follow-up was similar in the 2 groups.


CONCLUSIONS
An ED observation unit protocol that includes electrical cardioversion is a feasible alternative to routine hospital admission for acute onset of atrial fibrillation and results in a shorter initial length of stay.
Decker
Wyatt W
WW
Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. decker.wyatt@mayo.edu
Smars
Peter A
PA
Vaidyanathan
Lekshmi
L
Goyal
Deepi G
DG
Boie
Eric T
ET
Stead
Latha G
LG
Packer
Douglas L
DL
Meloy
Thomas D
TD
Boggust
Andy J
AJ
Haro
Luis H
LH
Laudon
Dennis A
DA
Lobl
Joseph K
JK
Sadosty
Annie T
AT
Schears
Raquel M
RM
Schiebel
Nicola E
NE
Hodge
David O
DO
Shen
Win-Kuang
WK
D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000628:therapy*; D001794:Blood Pressure; D004554:Electric Countershock; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome