Decker Wyatt W, Smars Peter A, Vaidyanathan Lekshmi, Goyal Deepi G, Boie Eric T, Stead Latha G, Packer Douglas L, Meloy Thomas D, Boggust Andy J, Haro Luis H, Laudon Dennis A, Lobl Joseph K, Sadosty Annie T, Schears Raquel M, Schiebel Nicola E, Hodge David O, Shen Win-Kuang
Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Ann Emerg Med. 2008 Oct;52(4):322-8. doi: 10.1016/j.annemergmed.2007.12.015. Epub 2008 Mar 14.
An emergency department (ED) observation unit protocol for the management of acute onset atrial fibrillation is compared with routine hospital admission and management.
Adult patients presenting to the ED with atrial fibrillation of less than 48 hours' duration without hemodynamic instability or other comorbid conditions requiring hospitalization were enrolled. Participants were randomized to either ED observation unit care or routine inpatient care. The ED observation unit protocol included pulse rate control, cardiac monitoring, reassessment, and electrical cardioversion if atrial fibrillation persisted. Patients who reverted to sinus rhythm were discharged with a cardiology follow-up within 3 days, whereas those still in atrial fibrillation were admitted. All cases were followed up for 6 months and adverse events recorded.
Of the 153 patients, 75 were randomized to the ED observation unit and 78 to routine inhospital care. Eighty-five percent of ED observation unit patients converted to sinus rhythm versus 73% in the routine care group (difference 12%; 95% confidence interval [CI] -1% to 25%]; P=.06). The median length of stay was 10.1 versus 25.2 hours (difference 15.1 hours; 95% CI 11.2 to 19.6; P<.001) for ED observation unit and inhospital care respectively. Nine ED observation unit patients required inpatient admission. Eleven percent of the ED observation unit group had recurrence of atrial fibrillation during follow-up versus 10% of the routine inpatient care group (difference 1%; 95% CI -9% to 11%; P=.93). There was no significant difference between the groups in the frequency of hospitalization or the number of tests, and the number of adverse events during follow-up was similar in the 2 groups.
An ED observation unit protocol that includes electrical cardioversion is a feasible alternative to routine hospital admission for acute onset of atrial fibrillation and results in a shorter initial length of stay.
将急诊科（ED）针对急性发作房颤的观察单元管理方案与常规住院治疗及管理进行比较。
纳入年龄≥18岁、因房颤就诊于急诊科且病程小于48小时、无血流动力学不稳定或其他需要住院治疗的合并症的患者。参与者被随机分为ED观察单元治疗组或常规住院治疗组。ED观察单元管理方案包括控制脉率、心脏监测、重新评估，若房颤持续则进行电复律。恢复窦性心律的患者在3天内接受心脏病学随访后出院，仍处于房颤状态的患者则收住院。所有病例随访6个月并记录不良事件。
153例患者中，75例被随机分配至ED观察单元，78例接受常规住院治疗。ED观察单元组85%的患者转为窦性心律，常规治疗组为73%（差异12%；95%置信区间[CI]-1%至25%；P = 0.06）。ED观察单元组和住院治疗组的中位住院时间分别为10.1小时和25.2小时（差异15.1小时；95%CI 11.2至19.6；P<0.001）。ED观察单元组有9例患者需要住院治疗。ED观察单元组11%的患者在随访期间房颤复发，常规住院治疗组为10%（差异1%；95%CI -9%至11%；P = 0.93）。两组在住院频率、检查次数方面无显著差异，两组随访期间不良事件的数量相似。
包含电复律的ED观察单元管理方案是急性发作房颤常规住院治疗的可行替代方案，且初始住院时间更短。
