Grupo de Arritmias Cardiacas, de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES). Servicio de Urgencias del Hospital Universitario Virgen del Rocío de Sevilla, España.
Grupo de Arritmias Cardiacas, de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) Área de Urgencias. Grup de Recerca "Urgències: processos i patologies". IDIBAPS. Unitat de Fibrillació Auricular (UFA). Hospital Clínic. Barcelona, España.
Emergencias. 2019;31(4):227-233.
To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified.
Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm.
We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238-0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2-13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6-4.3; P< .001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5-4.8; P< .003).
Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents.
分析医院急诊科的心率控制情况以及新发心房颤动（AF）患者的结局，以便确定改进目标。
这是一项多中心、前瞻性观察性横断研究，在西班牙卫生服务的 124 家代表性医院中进行，基于 2011 年 5 月 23 日至 6 月 5 日 HERMES-AF 数据库（医院急诊管理策略心房颤动）中的记录。当决定尝试恢复窦性心律时，招募了在发病后 48 小时内出现症状性 AF 的患者。
共纳入 337 例患者。在一半的情况下药物治疗失败后，311 例（92.3%）使用化学电复律，52 例（15%）使用电复律。278 例（82.5%）患者恢复窦性心律，94%患者症状缓解。记录到 0.9%的不良反应，但均不严重。胺碘酮与恢复窦性心律的较低率独立相关（比值比[OR]，0.442；95%可信区间[CI]，0.238-0.823；P=.01），而电复律（OR，4.0；95% CI，1.2-13.3；P=.024）。使用 Ic 类抗心律失常药物与 6 小时内出院率更高相关（OR，2.6；95% CI，1.6-4.3；P<.001），而胺碘酮与住院时间超过 24 小时相关（OR，2.7；95% CI，1.5-4.8；P<.003）。
AF 患者在急诊科恢复窦性心律是安全、有效且具有临床益处的。通过用更快速、更有效的治疗方法（如电复律或使用 Ic 类药物）替代胺碘酮的使用，可以提高护理质量。
