Abstract
Background
We sought to evaluate safety of electrical cardioversion (ECV) for patients with acute
atrial fibrillation (AF) or atrial flutter (AFL) in the emergency department (ED).
Methods
This was an analysis of data from 4 multicentre AF/AFL studies conducted from 2008
to 2019 at 23 large EDs. We included adult patients who received attempts at ECV and
who had presented acutely after symptom onset. Staff manually reviewed study and clinical
records to abstract data.
Results
We evaluated 1736 ECV cases with a mean age of 60.1 years and 67.1% male. The overall
success of ECV was 90.2% (95% confidence interval 88.7%-91.6%), with 4.9% of patients
admitted. ED physicians performed the ECV in 95.2% and provided sedation in 96.5%;
13.9% (12.3%-15.7%) of cases experienced important adverse events that required treatment,
and 0.4% were classified as life threatening. Another 5.6% had adverse events that
did not require treatment. Logistic regression found that the RAFF-3 study cohort
(odds ratio [OR] 2.0), age ≥ 85 years (OR 2.1), coronary artery disease (OR 1.5),
midazolam (OR 1.9), and fentanyl (OR 1.5) were associated with important adverse events.
Conclusions
This large evaluation of the safety of ECV for acute AF/AFL in the ED found that while
serious adverse events were rare, there were a concerning number of events following
sedation that required intervention. Physicians should be aware that older age, coronary
artery disease, and fentanyl are associated with higher risks of important adverse
events. This study provides more information for shared decision making discussions
with patients when choosing between drug-shock and shock-only cardioversion strategies.
Résumé
Contexte
Nous avons cherché à évaluer la sûreté de la cardioversion électrique (CVE) pour les
patients présentant des épisodes de fibrillation auriculaire (FA) ou de flutter auriculaire
au sein de services d'urgences (SU).
Méthodes
Il s'agit d'une analyse des données de quatre études multicentriques portant sur la
FA/le flutter menées de 2008 à 2019 dans 23 grands SU. Nous avons inclus des patients
adultes qui ont bénéficié d'essais de CVE et qui s'étaient présentés en urgence après
l'apparition de symptômes. Le personnel a parcouru manuellement les fiches d'étude
et les dossiers cliniques pour en extraire les données.
Résultats
Nous avons évalué 1 736 cas de CVE avec un âge moyen de 60,1 ans et 67,1 % d'hommes.
La réussite globale de la CVE était de 90,2 % (intervalle de confiance à 95 % : 88,7
%-91,6 %), avec 4,9 % des patients admis. Les urgentistes ont pratiqué la CVE dans
95,2 % des cas et ont assuré la sédation dans 96,5 % des cas; 13,9 % (12,3 %-15,7
%) des cas ont éprouvé des effets indésirables importants qui ont nécessité un traitement,
et 0,4 % ont été classés comme étant une menace vitale. Par ailleurs, 5,6 % des patients
ont expérimenté des effets indésirables qui n'ont pas nécessité de traitement. Une
régression logistique a révélé que la cohorte de l'étude RAFF-3 (rapport de cotes
[RC] 2,0), l'âge ≥ 85 ans (RC 2,1), la coronaropathie (RC 1,5), le midazolam (RC 1,9)
et le fentanyl (RC 1,5) étaient associés à des effets indésirables importants.
Conclusions
Cette vaste évaluation de la sécurité de la CVE pour des épisodes de FA/flutter aux
urgences a révélé que, si les effets indésirables graves étaient rares, un nombre
inquiétant d'événements survenus après sédation ont nécessité une intervention. Les
médecins doivent savoir que l'âge avancé, la maladie coronarienne et le fentanyl sont
associés à des risques plus élevés d'effets indésirables importants. Cette étude fournit
davantage d'informations pour les discussions en vue d'une prise de décision partagée
avec les patients lors du choix entre les stratégies de choc électrique externe associé
à un traitement médicamenteux ou par choc seul.
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Article info
Publication history
Published online: August 30, 2021
Accepted:
August 26,
2021
Received:
May 31,
2021
Footnotes
See page 1781 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
