EBQ:48hr Cardioversion for Afib: Difference between revisions
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==Clinical Question== | ==Clinical Question== | ||
For patients presenting with [[Atrial Fibrillation]] lasting less than 48 hours, what is the incidence of [[cardioversion]]-related [[thromboembolism]]? | '''For patients presenting with [[Atrial Fibrillation]] lasting less than 48 hours, what is the incidence of [[cardioversion]]-related [[thromboembolism]]?''' | ||
==Conclusion== | ==Conclusion== | ||
*Among patients with [[Atrial Fibrillation]] clinically estimated to be <48 hours, the likelihood of [[cardioversion]]-related clinical [[thromboembolism]] is very low | '''*Among patients with [[Atrial Fibrillation]] clinically estimated to be <48 hours, the likelihood of [[cardioversion]]-related clinical [[thromboembolism]] is very low | ||
* | *This data support early cardioversion in these patients''' | ||
==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. | |||
==Study Design== | ==Study Design== | ||
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==Additional Resources== | |||
[[http://blog.ercast.org/2012/10/should-we-cardiovert-atrial-fibrillation-in-the-ed/ ERCast Podcast-Cardioversion]] | |||
==Funding== | ==Funding== | ||
Revision as of 15:14, 1 April 2014
PubMed Full text PDF
Clinical Question
For patients presenting with Atrial Fibrillation lasting less than 48 hours, what is the incidence of cardioversion-related thromboembolism?
Conclusion
*Among patients with Atrial Fibrillation clinically estimated to be <48 hours, the likelihood of cardioversion-related clinical thromboembolism is very low
- This data support early cardioversion in these patients
Major Points
Cardioversion of atrial fibrillation is necessary toimprove cardiac function, relieve symptoms and decrease the rate of thrombus formation.[1]. 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.[2] 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
Population
Inclusion Criteria
Exclusion Criteria
Interventions
Outcome
Primary Outcomes
Secondary Outcomes
Subgroup analysis
Criticisms & Further Discussion
Additional Resources
[ERCast Podcast-Cardioversion]