EBQ:48hr Cardioversion for Afib - Revision history

Danbot: Added interventions section content

2026-03-21T22:35:38Z

Added interventions section content

← Older revision		Revision as of 22:35, 21 March 2026
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	*Presentation witih an acute thromboembolism		*Presentation witih an acute thromboembolism
	*On long term warfarin with INR >1.6		*On long term warfarin with INR >1.6
	==Interventions==		==Interventions==
			*Cardioversion (electrical or pharmacological) or spontaneous conversion after rate control
			*No specific intervention was mandated; treatment was at discretion of attending physician
			*Patients were followed for thromboembolic events following conversion to sinus rhythm

	==Outcomes==		==Outcomes==

Ostermayer: /* Funding */

2015-01-26T15:04:02Z

Funding

← Older revision		Revision as of 15:04, 26 January 2015
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	==Funding==		==Funding==
			None

	==Sources==		==Sources==

Ostermayer: /* Major Points */

2015-01-26T14:52:28Z

Major Points

← Older revision		Revision as of 14:52, 26 January 2015
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	==Major Points==		==Major Points==
	*Cardioversion of atrial fibrillation is necessary to improve cardiac function, relieve symptoms and decrease the rate of thrombus formation.<ref>Pritchett E et al. Management of atrial fibrillation. NEJM. 1992;326:1264-71</ref>. With many patients presenting acutely for new onset atrial fibrillation within 48hrs, this study assessed the risk of thromboembolic event following ~~cardiovrsion~~ or spontaneous conversion after rate control. Of the 357 patients converted to sinus rhythm within the first 48hrs only 3 patients (0.8%) experienced a thromboembolic event.		*Cardioversion of atrial fibrillation is necessary to improve cardiac function, relieve symptoms and decrease the rate of thrombus formation.<ref>Pritchett E et al. Management of atrial fibrillation. NEJM. 1992;326:1264-71</ref>. With many patients presenting acutely for new onset atrial fibrillation within 48hrs, this study assessed the risk of thromboembolic event following cardioversion or spontaneous conversion after rate control. Of the 357 patients converted to sinus rhythm within the first 48hrs only 3 patients (0.8%) experienced a thromboembolic event.

	*An ~~editional~~ review of 5 studies on the ~~saftey~~ of ED cardioversion suggest that the major complication ~~occuring~~ from ED cardioversion relates to the procedural sedation with rare complications from the cardioversion event.<ref>von Besser K. et al. Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation? Ann Emerg Med. 2011 Dec;58(6):517-20</ref>		*An additional review of 5 studies on the safety of ED cardioversion suggest that the major complication occurring from ED cardioversion relates to the procedural sedation with rare complications from the cardioversion event.<ref>von Besser K. et al. Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation? Ann Emerg Med. 2011 Dec;58(6):517-20</ref>

	*The [[EBQ:Ottawa Aggressive ED Cardioversion Protocol]] demonstrates the ~~saftey~~ and effectiveness of ED cardioversion of new onset Atrial Fib within 48hrs if appropriate followup exists for patients.		*The [[EBQ:Ottawa Aggressive ED Cardioversion Protocol]] demonstrates the safety and effectiveness of ED cardioversion of new onset Atrial Fib within 48hrs if appropriate followup exists for patients.

	==Study Design==		==Study Design==

Ostermayer: Reverted edits by Ostermayer (talk) to last revision by MBMD

2014-10-23T11:48:20Z

Reverted edits by Ostermayer (talk) to last revision by MBMD

← Older revision		Revision as of 11:48, 23 October 2014
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	*'''Mean duration of atrial fibriliation prior to cardioversion: 1.7 days'''		*'''Mean duration of atrial fibriliation prior to cardioversion: 1.7 days'''

	*'''Thromboembolism on Anticoagulation (including asprin) vs. No Anticoagulation~~'''~~		*Thromboembolism on ''Anticoagulation'' vs. ''No Anticoagulation (including aspirin)''
			:''0.8%'' vs ''0.9%'' (p >0.2)

			*Thromboembolism on Anticoagulation(including asprin) vs. No Anticoagulation
	:''1.3%'' vs ''0.5%'' (p>0.2)		:''1.3%'' vs ''0.5%'' (p>0.2)
	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==

Ostermayer at 11:43, 23 October 2014

2014-10-23T11:43:56Z

← Older revision		Revision as of 11:43, 23 October 2014
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	*'''Mean duration of atrial fibriliation prior to cardioversion: 1.7 days'''		*'''Mean duration of atrial fibriliation prior to cardioversion: 1.7 days'''

	*~~Thromboembolism on ''Anticoagulation'' vs. ''No Anticoagulation (including aspirin)''~~		*'''Thromboembolism on Anticoagulation (including asprin) vs. No Anticoagulation'''
	~~:''0.8%'' vs '~~'~~0.9%~~'' ~~(p >0.2)~~

	*Thromboembolism on Anticoagulation(including asprin) vs. No Anticoagulation
	:''1.3%'' vs ''0.5%'' (p>0.2)		:''1.3%'' vs ''0.5%'' (p>0.2)
	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==

MBMD: Grammatical correction

2014-09-24T18:23:49Z

Grammatical correction

← Older revision		Revision as of 18:23, 24 September 2014
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	==Major Points==		==Major Points==
	*Cardioversion of atrial fibrillation is necessary ~~toimprove~~ cardiac function, relieve symptoms and decrease the rate of thrombus formation.<ref>Pritchett E et al. Management of atrial fibrillation. NEJM. 1992;326:1264-71</ref>. With many patients presenting acutely for new onset atrial fibrillation within 48hrs, this study assessed the risk of thromboembolic event following cardiovrsion or spontaneous conversion after rate control. Of the 357 patients converted to sinus rhythm within the first 48hrs only 3 patients (0.8%) experienced a thromboembolic event.		*Cardioversion of atrial fibrillation is necessary to improve cardiac function, relieve symptoms and decrease the rate of thrombus formation.<ref>Pritchett E et al. Management of atrial fibrillation. NEJM. 1992;326:1264-71</ref>. With many patients presenting acutely for new onset atrial fibrillation within 48hrs, this study assessed the risk of thromboembolic event following cardiovrsion or spontaneous conversion after rate control. Of the 357 patients converted to sinus rhythm within the first 48hrs only 3 patients (0.8%) experienced a thromboembolic event.

	*An editional review of 5 studies on the saftey of ED cardioversion suggest that the major complication occuring from ED cardioversion relates to the procedural sedation with rare complications from the cardioversion event.<ref>von Besser K. et al. Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation? Ann Emerg Med. 2011 Dec;58(6):517-20</ref>		*An editional review of 5 studies on the saftey of ED cardioversion suggest that the major complication occuring from ED cardioversion relates to the procedural sedation with rare complications from the cardioversion event.<ref>von Besser K. et al. Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation? Ann Emerg Med. 2011 Dec;58(6):517-20</ref>

Me7sn at 13:05, 11 April 2014

2014-04-11T13:05:08Z

← Older revision		Revision as of 13:05, 11 April 2014
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	*An editional review of 5 studies on the saftey of ED cardioversion suggest that the major complication occuring from ED cardioversion relates to the procedural sedation with rare complications from the cardioversion event.<ref>von Besser K. et al. Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation? Ann Emerg Med. 2011 Dec;58(6):517-20</ref>		*An editional review of 5 studies on the saftey of ED cardioversion suggest that the major complication occuring from ED cardioversion relates to the procedural sedation with rare complications from the cardioversion event.<ref>von Besser K. et al. Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation? Ann Emerg Med. 2011 Dec;58(6):517-20</ref>

	*The [[EBQ:~~Ottowa~~ Aggressive ED Cardioversion Protocol]] demonstrates the saftey and effectiveness of ED cardioversion of new onset Atrial Fib within 48hrs if appropriate followup exists for patients.		*The [[EBQ:Ottawa Aggressive ED Cardioversion Protocol]] demonstrates the saftey and effectiveness of ED cardioversion of new onset Atrial Fib within 48hrs if appropriate followup exists for patients.

	==Study Design==		==Study Design==

Ostermayer: Complete

2014-04-04T22:11:17Z

Complete

← Older revision		Revision as of 22:11, 4 April 2014
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	\| fulltexturl= http://annals.org/article.aspx?articleid=710444		\| fulltexturl= http://annals.org/article.aspx?articleid=710444
	\| pdfurl=http://bit.ly/1dKw6d8		\| pdfurl=http://bit.ly/1dKw6d8
	\| status=~~Under Review~~		\| status=Complete
	}}		}}
	==Clinical Question==		==Clinical Question==

Ostermayer: /* Additional Resources */

2014-04-02T15:25:10Z

Additional Resources

← Older revision		Revision as of 15:25, 2 April 2014
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	==Additional Resources==		==Additional Resources==
	[[http://blog.ercast.org/2012/10/should-we-cardiovert-atrial-fibrillation-in-the-ed/ ERCast Podcast-Cardioversion]]		[http://blog.ercast.org/2012/10/should-we-cardiovert-atrial-fibrillation-in-the-ed/ ERCast Podcast-Cardioversion]

	==Funding==		==Funding==

Ostermayer at 15:24, 2 April 2014

2014-04-02T15:24:48Z

← Older revision		Revision as of 15:24, 2 April 2014
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	==Major Points==		==Major Points==
	Cardioversion of atrial fibrillation is necessary toimprove cardiac function, relieve symptoms and decrease the rate of thrombus formation.<ref>Pritchett E et al. Management of atrial fibrillation. NEJM. 1992;326:1264-71</ref>. With many patients presenting acutely for new onset atrial fibrillation within 48hrs, this study assessed the risk of thromboembolic event following cardiovrsion or spontaneous conversion after rate control. Of the 357 patients converted to sinus rhythm within the first 48hrs only 3 patients (0.8%) experienced a thromboembolic event. An editional review of 5 studies on the saftey of ED cardioversion suggest that the major complication occuring from ED cardioversion relates to the procedural sedation with rare complications from the cardioversion event.<ref>von Besser K. et al. Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation? Ann Emerg Med. 2011 Dec;58(6):517-20</ref> The [[EBQ:Ottowa Aggressive ED Cardioversion Protocol]] demonstrates the saftey and effectiveness of ED cardioversion of new onset Atrial Fib within 48hrs if appropriate followup exists for patients.		*Cardioversion of atrial fibrillation is necessary toimprove cardiac function, relieve symptoms and decrease the rate of thrombus formation.<ref>Pritchett E et al. Management of atrial fibrillation. NEJM. 1992;326:1264-71</ref>. With many patients presenting acutely for new onset atrial fibrillation within 48hrs, this study assessed the risk of thromboembolic event following cardiovrsion or spontaneous conversion after rate control. Of the 357 patients converted to sinus rhythm within the first 48hrs only 3 patients (0.8%) experienced a thromboembolic event.

			*An editional review of 5 studies on the saftey of ED cardioversion suggest that the major complication occuring from ED cardioversion relates to the procedural sedation with rare complications from the cardioversion event.<ref>von Besser K. et al. Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation? Ann Emerg Med. 2011 Dec;58(6):517-20</ref>

			*The [[EBQ:Ottowa Aggressive ED Cardioversion Protocol]] demonstrates the saftey and effectiveness of ED cardioversion of new onset Atrial Fib within 48hrs if appropriate followup exists for patients.

	==Study Design==		==Study Design==
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	:''1.3%'' vs ''0.5%'' (p>0.2)		:''1.3%'' vs ''0.5%'' (p>0.2)
	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
			*This study was not an ED population however patients were of a similar population as most ED patients.
			*No clear conclusions can be drawn from the subgroup analysis regarding need for anticoagulation prior to cardioversion.
			*The ACCP, recommend against acute anticoagulation for high risk patients getting cardioversion (Grade 2C)<ref>Singer D. et al. Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.Chest. 2004 Sep;126(3 Suppl):429S-456S</ref>