急诊行电复律治疗的房颤或房扑患者 30 天结局。

Thirty-day outcomes of emergency department patients undergoing electrical cardioversion for atrial fibrillation or flutter.

机构信息

Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, USA.

出版信息

Acad Emerg Med. 2010 Apr;17(4):408-15. doi: 10.1111/j.1553-2712.2010.00697.x.

DOI:10.1111/j.1553-2712.2010.00697.x

PMID:20370780

Abstract

OBJECTIVES

While the short-term (<7-day) safety and efficiency of electrical cardioversion for emergency department (ED) patients with atrial fibrillation or flutter have been established, the 30-day outcomes with respect to stroke, thromboembolic events, or death have not been investigated.

METHODS

A two-center cohort of consecutive ED patients undergoing cardioversion for atrial fibrillation or flutter between January 1, 2000, and September 30, 2007, was retrospectively investigated. This cohort was probabilistically linked with both a regional ED database and the provincial health registry to determine which patients had a subsequent ED visit or hospital admission, stroke, or thromboembolic event or died within 30 days. In addition, trained reviewers performed a detailed chart abstraction on 150 randomly selected patients, with emphasis on demographics, vital signs, medical treatment, and predefined adverse events. Hemodynamically unstable patients or those whose condition was the result of an underlying acute medical diagnosis were excluded. Data were analyzed by descriptive methods.

RESULTS

During the study period, 1,233 patients made 1,820 visits for atrial fibrillation or flutter to the ED. Of the 400 eligible patients undergoing direct-current cardioversion (DCCV), no patients died, had a stroke, or had a thromboembolic event in the following 30 days (95% confidence interval [CI] = 0.0 to 0.8% for all outcomes). A total of 141 patients were included in the formal chart review, with five patients (3.5%, 95% CI = 0.5% to 6.6%) failing cardioversion, six patients (4.3%, 95% CI = 0.9% to 7.6%) having a minor adverse event that did not change disposition, and five patients (3.5%, 95% CI = 0.5% to 6.6%) admitted to hospital at the index visit.

CONCLUSIONS

Cardioversion of patients with atrial fibrillation or flutter in the ED appears to have a very low rate of long-term complications.

摘要

目的

虽然已经确定了急诊（ED）患者因心房颤动或心房扑动进行电复律的短期（<7 天）安全性和有效性，但尚未研究 30 天内与中风、血栓栓塞事件或死亡相关的结果。

方法

回顾性调查了 2000 年 1 月 1 日至 2007 年 9 月 30 日期间在两个中心的 ED 接受心房颤动或心房扑动电复律的连续患者队列。该队列通过区域 ED 数据库和省级健康登记处进行概率性链接，以确定哪些患者在 30 天内有后续的 ED 就诊或住院、中风或血栓栓塞事件或死亡。此外，经过培训的审查员对 150 名随机选择的患者进行了详细的图表摘录，重点关注人口统计学、生命体征、医疗治疗和预定义的不良事件。排除血流动力学不稳定的患者或其病情是潜在急性医学诊断结果的患者。数据通过描述性方法进行分析。

结果

在研究期间，1233 名患者因心房颤动或心房扑动到 ED 就诊 1820 次。在 400 名符合条件的接受直流电复律（DCCV）的患者中，在接下来的 30 天内没有患者死亡、中风或发生血栓栓塞事件（所有结局的 95%置信区间 [CI] = 0.0 至 0.8%）。共有 141 名患者纳入正式的图表审查，其中 5 名患者（3.5%，95%CI=0.5%至 6.6%）复律失败，6 名患者（4.3%，95%CI=0.9%至 7.6%）发生轻微不良事件但未改变处置方式，5 名患者（3.5%，95%CI=0.5%至 6.6%）在指数就诊时住院。