Department of Electrophysiology and Clinical Arrhythmology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, C.so Europa 250, Rho, 20017, Milan, Italy.
Intern Emerg Med. 2020 Jan;15(1):1-4. doi: 10.1007/s11739-019-02225-x. Epub 2019 Dec 13.
Atrial fibrillation is the most common sustained arrhythmia encountered in primary care practice and represents a significant burden on the health care system with a higher than expected hospitalization rate from the emergency department. The first goal of therapy is to assess the patient's symptoms and hemodynamic status. There are multiple acute management strategies for atrial fibrillation including heart rate control, immediate direct-current cardioversion, or pharmacologic cardioversion. Given the variety of approaches to acute atrial fibrillation, it is often difficult to consistently provide cost-effectiveness care. The likelihood of spontaneous conversion of acute atrial fibrillation to sinus rhythm is reported to be really high. Although active cardioversion of recent-onset atrial fibrillation is generally considered to be safe, the question arises of whether the strategy of immediate treatment for a condition that is likely to resolve spontaneously is acceptable for hemodynamically stable patients. Based on published data, non-managed acute treatment of atrial fibrillation appears to be cost-saving. The observation of a patient with recent-onset atrial fibrillation in a dedicated unit within the emergency department reduces the need for acute cardioversion in almost two-thirds of the patients, and reduces the median length of stay, without negatively affecting long-term outcome, thus reducing the related health care costs. However, to let these results broadly applicable, defined treatment algorithms and access to prompt follow-up are needed, which may not be practical in all settings.
心房颤动是初级保健实践中最常见的持续性心律失常，它给医疗保健系统带来了巨大的负担，其急诊科的住院率高于预期。治疗的首要目标是评估患者的症状和血液动力学状况。心房颤动有多种急性管理策略，包括心率控制、立即直流电复律或药物复律。鉴于急性心房颤动的治疗方法多种多样，因此很难始终如一地提供具有成本效益的护理。据报道，急性心房颤动自发转为窦性心律的可能性非常高。虽然最近发作的心房颤动的主动复律通常被认为是安全的，但对于血液动力学稳定的患者，是否可以接受对可能自发缓解的病症进行即刻治疗的策略，这是一个存在争议的问题。基于已发表的数据，对心房颤动的急性非管理治疗似乎可以节省成本。在急诊科的专门病房中观察到近期发作的心房颤动患者，可使近三分之二的患者无需进行急性复律，并且可以缩短中位住院时间，而不会对长期预后产生负面影响，从而降低相关的医疗保健费用。然而，要使这些结果广泛适用，需要制定明确的治疗算法并能够及时进行随访，但在所有情况下可能都不切实际。
