Kriz R, Freynhofer M K, Weiss T W, Egger F, Gruber S C, Eisenburger P, Wojta J, Huber K, Koch J
Department of Emergency Medicine, Wilhelminen Hospital, Vienna, Austria; 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
Am J Emerg Med. 2016 Aug;34(8):1486-90. doi: 10.1016/j.ajem.2016.05.012. Epub 2016 May 11.
The management of patients with recent-onset atrial fibrillation (AF) presenting at emergency departments (EDs) varies widely. Our aim was to describe the management of patients with recent-onset (<48 hours) AF, to determine safety and efficacy of pharmacological cardioversion at the ED, and to evaluate the incidence of thromboembolism or death at 30 days.
In a prospective, observational, single-center study, 236 subjects with recent-onset AF were consecutively enrolled from January 2011 until January 2013. Follow-up information was obtained by reviewing all available clinical records.
As first-line therapy, 45.3% (n = 107) received ibutilide, 28.8% (n = 68) vernakalant, 25% (n = 59) flecainide, and 0.8% (n = 2) amiodarone, respectively. Successful cardioversion was achieved in 72.5% (n = 171) of patients after first-line therapy. There was no significant difference between treatment groups. In univariable logistic regression analysis, age (odds ratio [OR] = 1.027; 95% confidence interval [CI], 1.003-1.052; P= .03), duration of symptoms (OR = 0.968; 95% CI, 0.938-0.999; P= .045), as well as the CHA2DS2-VASc score (1 point for Congestive heart failure, Hypertension, Age between 65 and 74 years, Diabetes, Vascular disease, Sex category if female and 2 points for previous TIA/Stroke and Age ≥ 75 years) (OR = 1.237; 95% CI, 1.01-1.515; P= .04) were associated with success of pharmacological cardioversion. Within 30 days, 1 patient suffered from fatal ischemic stroke.
Pharmacological cardioversion followed by discharge after a short observation period is safe. There was no significant difference between the agents used in terms of short-term safety and efficacy. Importantly, the coherence of the ED to recent guidelines regarding first-line therapy is high.
急诊科对近期发作的房颤（AF）患者的处理方式差异很大。我们的目的是描述近期发作（<48小时）房颤患者的处理情况，确定急诊科药物复律的安全性和有效性，并评估30天时血栓栓塞或死亡的发生率。
在一项前瞻性、观察性、单中心研究中，从2011年1月至2013年1月连续纳入236例近期发作房颤的患者。通过查阅所有可用的临床记录获得随访信息。
作为一线治疗，分别有45.3%（n = 107）接受伊布利特，28.8%（n = 68）接受维纳卡兰，25%（n = 59）接受氟卡尼，0.8%（n = 2）接受胺碘酮。一线治疗后72.5%（n = 171）的患者成功复律。各治疗组之间无显著差异。在单变量逻辑回归分析中，年龄（比值比[OR]=1.027；95%置信区间[CI]，1.003 - 1.052；P = 0.03）、症状持续时间（OR = 0.968；95% CI，0.938 - 0.999；P = 0.045）以及CHA2DS2 - VASc评分（充血性心力衰竭、高血压、65至74岁、糖尿病、血管疾病、女性性别类别计1分，既往短暂性脑缺血发作/中风及年龄≥75岁计2分）（OR = 1.237；95% CI，1.01 - 1.515；P = 0.04）与药物复律成功相关。30天内，1例患者发生致命性缺血性卒中。
短期观察后药物复律然后出院是安全的。所用药物在短期安全性和有效性方面无显著差异。重要的是，急诊科对近期指南一线治疗的依从性很高。
