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 Atrial Fibrillation Caused by Intractable Hiccups: A Unique Cause and Cure

2022 ◽  
Vol 2022 ◽  
pp. 1-4
Author(s):  
Joshua H. Arnold ◽  
Neil Brandon
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Electrical Cardioversion ◽  
Traditional Treatment ◽  
Cardiac Pathology ◽  
Normal Sinus ◽  
First Time ◽  
Intractable Hiccups

We present the case of a 61-year-old male who developed persistent hiccups concurrently with the onset of atrial fibrillation (AF). The hiccups were refractory to traditional treatment but resolved immediately upon electrical cardioversion (ECV) to normal sinus rhythm (NSR). The patient has remained in NSR and free of hiccups. The potential etiologies for hiccups are numerous and varied, and the management of persistent hiccups can be difficult. Cardiac associations including myocardial infarction and pericarditis have been described, while few cases of first-time onset of atrial fibrillation leading to hiccups have been documented. This case discusses a unique instance demonstrating a connection between hiccups and cardiac pathology and an overview of its management.

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.

scholarly journals An Atrial Fibrillation with Normal Limits using Signal Processing- A Review

2018 ◽  
Vol 7 (2.24) ◽  
pp. 453
Author(s):  
S. Sathish ◽  
K Mohanasundaram
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
P Wave ◽  
Wave Duration ◽  
Normal Limits ◽  
Normal Sinus ◽  
P Wave Duration ◽  
Standard Lead ◽  
Wave Morphology

Atrial fibrillation is an irregular heartbeat (arrhythmia) that can lead to the stroke, blood clots, heart failure and other heart related complications. This causes the symptoms like rapid and irregular heartbeat, fluttering, shortness of breath etc. In India for every around 4000 people eight of them are suffering from Atrial Fibrillation. P-wave Morphology.  Abnormality of P-wave (Atrial ECG components) seen during sinus rhythm are associated with Atrial fibrillation. P-wave duration is the best predictor of preoperative atrial fibrillation. but the small amplitudes of atrial ECG and its gradual increase from isometric line create difficulties in defining the onset of P wave in the Standard Lead Limb system (SLL).Studies shows that prolonged P-wave have duration in patients (PAF) In this Study, a Modified Lead Limb (MLL) which solves the practical difficulties in analyzing the P-ta interval for both in healthy subjects and Atrial Fibrillation patients. P-Ta wave interval and P-wave duration can be estimated with following proposed steps which is applicable for both filtered and unfiltered atrial ECG components which follows as the clinical database trials. For the same the p-wave fibrillated signals that escalates the diagnosis follows by providing minimal energy to recurrent into a normal sinus rhythm.  

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