Division of Emergency Services, Schwartz/Reisman Emergency Centre, Mount Sinai Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
CJEM. 2004 May;6(3):155-60. doi: 10.1017/s1481803500006849.
Paroxysmal atrial fibrillation (PAF) is the rhythm disturbance most commonly encountered by emergency physicians, yet the role played by emergency physicians in the management of this condition has not been well described. The purpose of this study was to describe the management of uncomplicated PAF by Canadian emergency physicians.
All members of the Canadian Association of Emergency Physicians with a Canadian address (n = 1255) were mailed a 15-point questionnaire regarding training/certification, hospital demographics and practice patterns regarding the management of uncomplicated PAF. Chi-squared analysis and Fisher's Exact test were performed to identify significant differences in reported practice patterns in relation to demographic variables. Significant associations were tested for interaction using the Mantel-Haenszel test.
We received 663 responses, representing a 52.8% response rate. Six hundred and twenty-two (95%), 514 (78%) and 242 (38%) respondents reported routine performance of rate control, chemical cardioversion and electrical cardioversion respectively. Physicians working in high-volume emergency departments (>50,000 visits/yr) were significantly more likely to self-manage rate control and chemical/electrical cardioversion than those working in lower volume emergency departments. Residency training was associated with higher performance of electrical (44% v. 31%, p < 0.01) but not chemical cardioversion or rate control, although, amongst residency trained physicians, those with FRCP-level training were significantly more likely to perform both chemical (86% v. 76%, p < 0.05) and electrical (57% v. 37%, p < 0.01) cardioversion.
Canadian emergency physicians surveyed in this study actively manage uncomplicated PAF. We found significant variations in practice, especially related to the use of electrical cardioversion. This may reflect different practice environments, levels of training, and lack of evidence to guide best practice. Further research is required to determine the optimal care of PAF in the emergency department setting.
阵发性心房颤动（PAF）是急诊医师最常遇到的节律紊乱，但急诊医师在这种情况下的管理作用尚未得到很好的描述。本研究的目的是描述加拿大急诊医师对单纯性 PAF 的管理。
向加拿大急诊医师协会所有在加拿大有地址的成员（n=1255）邮寄了一份 15 点的问卷，内容涉及培训/认证、医院人口统计学和管理单纯性 PAF 的实践模式。采用卡方分析和 Fisher 精确检验，以确定在人口统计学变量方面报告的实践模式的显著差异。使用 Mantel-Haenszel 检验对显著关联进行交互测试。
我们收到了 663 份回复，回复率为 52.8%。622（95%）、514（78%）和 242（38%）名受访者分别报告常规进行心率控制、化学转复和电转复。在人流量大的急诊部门（>50,000 人次/年）工作的医生比在人流量低的急诊部门工作的医生更有可能自行进行心率控制和化学/电转复。住院医师培训与电转复（44%比 31%，p<0.01）的实施相关，但与化学转复或心率控制无关，尽管在接受住院医师培训的医生中，接受 FRCP 水平培训的医生更有可能进行化学转复（86%比 76%，p<0.05）和电转复（57%比 37%，p<0.01）。
在这项研究中接受调查的加拿大急诊医师积极管理单纯性 PAF。我们发现实践中存在显著差异，特别是在电转复的使用方面。这可能反映了不同的实践环境、培训水平以及缺乏指导最佳实践的证据。需要进一步研究以确定急诊环境中 PAF 的最佳治疗方法。
