《渥太华激进方案与近期新发心房颤动或房扑急诊患者快速出院的相关性》

Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter.

机构信息

Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.

出版信息

CJEM. 2010 May;12(3):181-91. doi: 10.1017/s1481803500012227.

DOI:10.1017/s1481803500012227

PMID:20522282

Abstract

OBJECTIVE

There is no consensus on the optimal management of recent-onset episodes of atrial fibrillation or flutter. The approach to these conditions is particularly relevant in the current era of emergency department (ED) overcrowding. We sought to examine the effectiveness and safety of the Ottawa Aggressive Protocol to perform rapid cardioversion and discharge patients with these arrhythmias.

METHODS

This cohort study enrolled consecutive patient visits to an adult university hospital ED for recent-onset atrial fibrillation or flutter managed with the Ottawa Aggressive Protocol. The protocol includes intravenous chemical cardioversion, electrical cardioversion if necessary and discharge home from the ED.

RESULTS

A total of 660 patient visits were included, 95.2% involving atrial fibrillation and 4.9% involving atrial flutter. The mean age of patients enrolled was 64.5 years. In total, 96.8% were discharged home and, of those, 93.3% were in sinus rhythm. All patients were initially administered intravenous procainamide, with a 58.3% conversion rate. A total of 243 patients underwent subsequent electrical cardioversion with a 91.7% success rate. Adverse events occurred in 7.6% of cases: hypotension 6.7%, bradycardia 0.3% and 7-day relapse 8.6%. There were no cases of torsades de pointes, stroke or death. The median lengths of stay in the ED were as follows: 4.9 hours overall, 3.9 hours for those undergoing conversion with procainamide and 6.5 hours for those requiring electrical conversion.

CONCLUSION

This is the largest study to date to evaluate the Ottawa Aggressive Protocol, a unique approach to cardioversion for ED patients with recent-onset episodes of atrial fibrillation and flutter. Our data demonstrate that the Ottawa Aggressive Protocol is effective, safe and rapid, and has the potential to significantly reduce hospital admissions and expedite ED care.

摘要

目的

对于新发心房颤动或心房扑动的最佳管理方法尚未达成共识。在当前急诊部（ED）过度拥挤的时代，对这些病症的处理方法尤其重要。我们旨在研究渥太华激进方案（Ottawa Aggressive Protocol）在对新发心房颤动或心房扑动患者行快速电复律和出院方面的有效性和安全性。

方法

这项队列研究纳入了在一所成人大学医院 ED 因新发心房颤动或心房扑动而接受渥太华激进方案治疗的连续患者就诊。该方案包括静脉内化学电复律、必要时行电复律以及从 ED 出院回家。

结果

共纳入 660 例患者就诊，95.2%为心房颤动，4.9%为心房扑动。纳入患者的平均年龄为 64.5 岁。共有 96.8%的患者出院回家，其中 93.3%为窦性心律。所有患者最初均接受静脉内普鲁卡因胺治疗，转换率为 58.3%。共有 243 例患者随后行电复律，成功率为 91.7%。共有 7.6%的患者发生不良事件：低血压 6.7%，心动过缓 0.3%，7 天复发 8.6%。无尖端扭转型室速、中风或死亡病例。ED 的中位住院时间如下：总体为 4.9 小时，接受普鲁卡因胺转复者为 3.9 小时，需要电复律者为 6.5 小时。