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A Multicenter Randomized Trial to Evaluate a Chemical‐first or Electrical‐first Cardioversion Strategy for Patients With Uncomplicated Acute Atrial Fibrillation
- Source :
- Academic Emergency Medicine. 26:969-981
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- BACKGROUND Emergency department (ED) patients with uncomplicated atrial fibrillation (AF) of less than 48 hours may be safely managed with rhythm control. Although both chemical-first and electrical-first strategies have been advocated, there are no comparative effectiveness data to guide clinicians. METHODS At six urban Canadian centers, ED patients ages 18 to 75 with uncomplicated symptomatic AF of less than 48 hours and CHADS2 score of 0 or 1 were randomized using concealed allocation in a 1:1 ratio to one of the following strategies: 1) chemical cardioversion with procainamide infusion, followed by electrical countershock if unsuccessful; or 2) electrical cardioversion, followed by procainamide infusion if unsuccessful. The primary outcome was the proportion of patients discharged within 4 hours of arrival. Secondary outcomes included ED length-of-stay (LOS); prespecified ED-based adverse events; and 30-day ED revisits, hospitalizations, strokes, deaths, and quality of life (QoL). RESULTS Eighty-four patients were analyzed: 41 in the chemical-first group and 43 in the electrical-first group. Groups were balanced in terms of age, sex, vital signs, and CHADS2 scores. All patients were discharged home, with 83 (99%) in sinus rhythm. In the chemical-first group, 13 of 41 patients (32%) were discharged within 4 hours compared to 29 of 43 patients (67%) in the electrical-first group (p = 0.001). In the chemical-first group, the median ED LOS was 5.1 hours (interquartile range [IQR] = 3.5 to 5.9 hours) compared to 3.5 hours (IQR = 2.4 to 4.6 hours) in the electrical-first group, for a median difference of 1.2 hours (95% confidence interval = 0.4 to 2.0 hours, p
- Subjects :
- Adult
Male
Canada
Adolescent
medicine.medical_treatment
Electric Countershock
Procainamide
Cardioversion
law.invention
Young Adult
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
Quality of life
Interquartile range
law
Atrial Fibrillation
Humans
Medicine
Sinus rhythm
Stroke
Aged
business.industry
030208 emergency & critical care medicine
Atrial fibrillation
General Medicine
Emergency department
Length of Stay
Middle Aged
medicine.disease
Anesthesia
Quality of Life
Emergency Medicine
Female
Emergency Service, Hospital
business
Anti-Arrhythmia Agents
Subjects
Details
- ISSN :
- 15532712 and 10696563
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Academic Emergency Medicine
- Accession number :
- edsair.doi.dedup.....9c02b2667e47d260f2a25a884afde087