EBQ:48hr Cardioversion for Afib

incomplete Journal Club Article

Weigner MJ et al. "Risk for clinical thromboembolism associated with conversion to sinus rhythm in patients with atrial fibrillation lasting less than 48 hours". Ann Intern Med. 1997. 126(8):615-620.
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.. 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. 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.

Additional Resources

[ERCast Podcast-Cardioversion]