scholarly journals Intravenous amiodarone for acute pharmacological conversion of atrial fibrillation in the emergency department

CJEM ◽  
2002 ◽  
Vol 4 (06) ◽  
pp. 414-420 ◽  
Author(s):  
Richard S. Slavik
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Normal Sinus Rhythm ◽  
High Dose ◽  
Class Iii ◽  
Recent Onset ◽  
Normal Sinus ◽  
Published Evidence ◽  
Intravenous Amiodarone ◽  
Meta Analyses

ABSTRACTAtrial fibrillation (AF) is the most common arrhythmia seen in patients presenting to the emergency department (ED). Pharmacological conversion of atrial fibrillation to normal sinus rhythm (NSR) may be a feasible management strategy in selected patients. Recent guidelines have recommended intravenous amiodarone, a class III antiarrhythmic agent, for the conversion of AF to NSR. The purpose of this review is to examine the published evidence for the efficacy of IV amiodarone for the acute conversion of AF to NSR in the ED. Currently available data from 11 randomized, controlled trials and 3 meta analyses do not support the use of conventional doses of IV amiodarone for acute conversion in the ED. High dose IV or combined IV and oral administration may be effective as early as 8 hours in patients with recent-onset AF of ≤48 hour duration in patients without contraindications to these high dose regimens. There are no data to support the use of IV amiodarone for acute conversion in patients with an ejection fraction of <40% or clinical heart failure, so its use in these scenarios should be limited to symptomatic patients who are refractory to electrical conversion. More well-designed studies are required to determine the role of IV amiodarone for the acute conversion of AF in the ED.

scholarly journals Acute atrial fibrillation: high-dose IV amiodarone facilitates conversion to normal sinus rhythm. When is it necessary?

1998 ◽  
Vol 31 ◽  
pp. 370
Author(s):  
G. Cotter ◽  
E. Cotter-Metzkor ◽  
E. Kaluski ◽  
A. Biat ◽  
Y. Moshkovitz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
High Dose ◽  
Normal Sinus

scholarly journals “Wait and See” Approach to the Emergency Department Cardioversion of Acute Atrial Fibrillation

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Brian Doyle ◽  
Mark Reeves
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Routine Care ◽  
Spontaneous Resolution ◽  
Electrical Cardioversion ◽  
Normal Sinus ◽  
Degree Of Satisfaction ◽  
Wait And See

Objective. Acute atrial fibrillation often spontaneously resolves. This study aimed to investigate the outcomes and satisfaction of an evidence-based ED protocol employing a “wait and see” approach.Methods. A prospective observational cohort study of adult patients presenting to the Emergency Department with stable acute atrial fibrillation was performed. Patients were excluded if they were considered to be unstable, need hospitalization, or poor candidates for ED procedural sedation. Routine care was provided on the index visit, and suitable candidates were discharged and asked to return to the ED the following day for possible electrical cardioversion. Outcome measures included spontaneous reversion to sinus rhythm, success of cardioversion, length of stay, adverse event and return visits for AF within 30 days, and patient satisfaction.Results. Thirty five patient encounters were analysed over a 21-month period. Twenty two of the 35 patients (63%) had spontaneous resolution of atrial fibrillation upon presentation for potential cardioversion. All of the remaining patients underwent successful cardioversion to normal sinus rhythm without significant adverse events recorded. No patients required hospitalization. Three patients (9%) returned to the ED within 30 days for recurrence of atrial fibrillation. All patients were reported to be “very satisfied” with this approach.Conclusion. A “wait and see” approach to the ED electrical cardioversion of atrial fibrillation showed that almost two-thirds of patients had spontaneous resolution without requiring cardioversion or observation in the ED or hospital. All patients were successfully reverted to normal sinus rhythm and had a high degree of satisfaction.

scholarly journals Procainamide for the acute management of atrial fibrillation and flutter in the emergency department: a systematic review

2020 ◽  
Vol 43 (2) ◽  
pp. 21
Author(s):  
Fiona Tran ◽  
Daniela Junqueira ◽  
Jillian Meyer ◽  
Kevin Zhou ◽  
Maria Tan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Cohort Studies ◽  
Normal Sinus Rhythm ◽  
Data Extraction ◽  
Grey Literature ◽  
Electrical Cardioversion ◽  
Chemical Agent ◽  
Relative Risks ◽  
Normal Sinus

Introduction: Chemical or electrical cardioversion are utilized for acute atrial fibrillation or flutter (AFF) management in the emergency department (ED). Procainamide is a common chemical agent used in Canada; however, there are substantial practice variations. Method: Systematic search of five databases and grey literature completed. Randomized controlled trials (RCTs) and prospective controlled cohort studies including adults with acute AFF comparing procainamide with other cardioversion strategies were eligible. Two independent reviewers performed study selection and data extraction. Relative risks (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model. The protocol was registered with PROSPERO (CRD42019142080). Results: From 3847 potential citations, 6 studies were included (four RCTs and two cohort studies). Procainamide was less effective in achieving conversion to normal sinus rhythm (NSR) at 1st attempt compared to other chemical (RR 0.76; 95% CI: 0.65 to 0.90) and electrical (RR 0.72; 95% CI: 0.56 to 0.92) options. Procainamide in a drug-shock approach was as effective as electrical cardioversion alone in restoring NSR (RR 1.04; 95% CI 1.00 to 1.08). The occurrence of hypotension was higher in patients receiving procainamide compared to electrical cardioversion (RR 1.87; 95% CI: 1.14 to 3.06). Deaths and strokes were not well-reported. Conclusion: Procainamide is less effective than other chemical options and electrical cardioversion strategies to restore NSR. The efficacy of procainamide in a drug-shock approach is similar to electrical alone at restoring NSR. The evidence shows that hypotension is a common procainamide adverse effect suggesting that electrical cardioversion as a first approach is preferable.

Pharmacotherapy Options in Atrial Fibrillation: Focus on Vernakalant

2009 ◽  
Vol 1 ◽  
pp. CMT.S1079 ◽  
Author(s):  
Judy W.M. Cheng ◽  
Iwona Rybak
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
English Language ◽  
Normal Sinus Rhythm ◽  
Published Data ◽  
Antiarrhythmic Agents ◽  
Efficacy And Safety ◽  
Recent Onset ◽  
Normal Sinus ◽  
Phase Ii Studies

This article reviews the role of vernakalant in the management of atrial fibrillation (AF). Published data in English language were identified from MEDLINE and Current Content database (both 1966 to January 30, 2009). Vernakalant is an antiarrhythmic agent with sodium and ultra-rapid potassium channel blockage property and atrial selective effect. In clinical studies evaluating intravenous vernakalant in cardioversion of patients with recent onset AF, vernakalant improve the chance of acute restoration to normal sinus rhythm (NSR). In post-operative AF, the chance of conversion to NSR was also improved. Phase II studies demonstrated that oral vernakalant 300 mg or 600 mg twice daily successfully maintained normal sinus rhythm compared to placebo. Common side effects include dysgeusia, sneezing, and paresthesia. Future studies are needed to explore the efficacy and safety of using vernakalant with patient populations who are prone to AF, as well as its comparative efficacy and safety to other antiarrhythmic agents.

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