Background: Electrical cardioversion of ED patients is a well-described treatment strategy for those presenting within 48 hours of atrial fibrillation (AF) onset (non-anticoagulated) or longer if anticoagulated. The objective of this study was to describe the safety and outcomes of this practice in a cohort of patients undergoing ED electrical cardioversion for atrial fibrillation.
Methods: This retrospective health records survey investigated a 8-year cohort of consecutive ED patients presenting with AF who underwent electrical cardioversion in an academic, tertiary ED. Electronic and manual abstraction strategies were used, extracting data on demographics, clinical features, interventions, complications, and return visits within 1 month. Data were analyzed using descriptive statistics and agreement between trained abstractors on key variables was excellent (k=0.94-0.98).
Results: Data from 888 patients were analyzed (median age 61 years; range 14 to 95; 597 (67%) male). Mean AF duration was 3.4 hours (SD 1.9, 95% CI: 3.2-3.5) in non-anticoagulated patients, and 4.0 hours in anticoagulated patients (SD 1.9, 95% CI: 3.8-4.3). Electrical cardioversion was successful in 781 (88%) encounters. There were 3 major complications (3/888; 0.3%) and 123 minor complications (123/888; 14%). 85 (68%) were attributed to procedural sedation while 41 (33%) were attributed to electrical cardioversion. Those attributed to cardioversion were generally transient and mild (n=40); however, one post-cardioversion stroke was documented (1/888; 0.1%). 22 patients (2.5%) experienced brief peri-procedure desaturation ( < 85%) with 1 (0.1%) requiring a jaw thrust maneuver. 59 (6.7%) experienced peri-procedure hypotension; 1 (0.1%) was observed overnight in our clinical decision unit (management change). 741 patients (84%) were discharged following electrical cardioversion with a mean ED LOS of 218 minutes (SD 152, 95% CI: 206-231 min). 57 (6.4%) patients returned to the ED within 30 days; 43 (4.8%) returned with relapse of atrial fibrillation or flutter.
Conclusion: In this cohort of ED patients with atrial fibrillation, ED electrical cardioversion followed by discharge to home was largely safe and effective. Most complications were transient, mild, and attributable to procedural sedation. Serious complications attributable to cardioversion were very few.