Is delayed cardioversion the better approach in recent-onset atrial fibrillation? Yes.
Giovanni Luca BottoGiovanni TortoraPublished in: Internal and emergency medicine (2019)
Atrial fibrillation is the most common sustained arrhythmia encountered in primary care practice and represents a significant burden on the health care system with a higher than expected hospitalization rate from the emergency department. The first goal of therapy is to assess the patient's symptoms and hemodynamic status. There are multiple acute management strategies for atrial fibrillation including heart rate control, immediate direct-current cardioversion, or pharmacologic cardioversion. Given the variety of approaches to acute atrial fibrillation, it is often difficult to consistently provide cost-effectiveness care. The likelihood of spontaneous conversion of acute atrial fibrillation to sinus rhythm is reported to be really high. Although active cardioversion of recent-onset atrial fibrillation is generally considered to be safe, the question arises of whether the strategy of immediate treatment for a condition that is likely to resolve spontaneously is acceptable for hemodynamically stable patients. Based on published data, non-managed acute treatment of atrial fibrillation appears to be cost-saving. The observation of a patient with recent-onset atrial fibrillation in a dedicated unit within the emergency department reduces the need for acute cardioversion in almost two-thirds of the patients, and reduces the median length of stay, without negatively affecting long-term outcome, thus reducing the related health care costs. However, to let these results broadly applicable, defined treatment algorithms and access to prompt follow-up are needed, which may not be practical in all settings.
Keyphrases
- atrial fibrillation
- catheter ablation
- oral anticoagulants
- left atrial
- emergency department
- left atrial appendage
- liver failure
- direct oral anticoagulants
- healthcare
- primary care
- respiratory failure
- heart rate
- heart failure
- percutaneous coronary intervention
- drug induced
- end stage renal disease
- ejection fraction
- newly diagnosed
- blood pressure
- aortic dissection
- systematic review
- palliative care
- machine learning
- combination therapy
- prognostic factors
- extracorporeal membrane oxygenation
- risk factors
- randomized controlled trial
- quality improvement
- peritoneal dialysis
- patient reported outcomes
- depressive symptoms
- intensive care unit
- hepatitis b virus
- venous thromboembolism
- social media
- smoking cessation
- mitral valve
- patient reported
- acute respiratory distress syndrome