Electrical Cardioversion Effective for Acute A-Fib in Emergency Setting

Both drug-shock, shock-only strategies are highly effective in emergency department patients with acute atrial fibrillation.

HealthDay News — For patients in the emergency department with acute atrial fibrillation, pharmacological cardioversion followed by electrical cardioversion (drug-shock) and electrical cardioversion alone (shock-only) strategies are highly effective for restoring sinus rhythm, with similar outcomes for different pad positions, according to a study published in the Feb. 1 issue of The Lancet.

Ian G. Stiell, M.D., from the University of Ottawa in Canada, and colleagues conducted a partial factorial trial of two protocols for 396 patients with acute atrial fibrillation. Protocol 1 compared attempted pharmacological cardioversion to intravenous procainamide followed by electrical cardioversion, if necessary, and placebo infusion plus electrical cardioversion. Protocol 2 compared anteroposterior and anterolateral pad positions among patients having electrical cardioversion.

The researchers found that conversion to sinus rhythm occurred in 96 and 92 percent of patients in the drug-shock and shock-only groups, respectively (absolute difference, 4 percent; 95 percent confidence interval, 0 to 9 percent; P = 0.07). Overall, 97 and 95 percent of patients, respectively, were discharged home (P = 0.60). In the drug-shock group, 52 percent of patients converted after drug infusion only. In follow-up, no patients had serious adverse events. Similar conversions to sinus rhythm were seen with anterolateral and anteroposterior pad positions in protocol 2 (94 versus 92 percent; P = 0.68).

“Cardioversion in the emergency department is safe and effective,” Steill said in a statement. “We hope our results convince more physicians around the world to adopt these methods.”

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