Management of acute atrial fibrillation in the emergency department: A recent experience

摘要

We would like to thank you for the excellent review by Coll-Vinent et al [1] published recently in your journal in relation to the safety of cardioversion to sinus rhythm in patients with atrial fibrillation (AF) at the emergency department (ED). The aim of this letter is to describe our hospital's ED experience, which, we believe, is highly related to the review by Coll-Vinent and colleagues and can provide some new data on this controversial subject. Between 2009 and 2010, we assessed 218 episodes of AFat the ED of our hospital, a tertiary care hospital with an average of 350-400 daily emergencies. The mean age of the patients was 66.6 years, 51.3% of them being men. A total of 50.4% of patients presented with palpitations, whereas 21.5% were an incidental finding. The average heart rate was 129beats/min. The length of AF was considered to be below 48 h in 67.5% of patients. In 50.4% of patients, it was a first-episode AF, whereas 34.4% of patients had a history of paroxysmal AF Spontaneous sinus rhythm conversion was observed in 12 patients (5.5%); pharmacological cardioversion was attempted in 206 patients but sinus rhythm was finally acquired only in 100 (45.9%). For the remaining 106 patients (48.6%), biphasic direct current cardioversion (DGG) was performed and was successful for all. The most widely chosen drug for pharmacological cardioversion was amiodarone (64.6%), followed by propafenone (14.6%) and flecainide (2.2%). There were no complications after cardioversion (pharmacological or DGC) in any patient. The rate of recurrences and readmissions into the ED at 30 days was 10.5%. The study was approved by the ethics committee of the hospital.