经食管超声心动图引导的心房颤动大于 48 小时的急诊科与心内科病房患者电复律的结局：一项回顾性比较研究。

Outcomes of transesophageal echocardiogram-guided electrical cardioversion in patients with atrial fibrillation greater than 48 hours treated in the emergency department versus the cardiology ward: A retrospective comparison study.

机构信息

Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.

Faculty of Medicine, Hebrew University of Jerusalem, Israel.

出版信息

Int J Clin Pract. 2021 Sep;75(9):e14480. doi: 10.1111/ijcp.14480. Epub 2021 Jun 28.

DOI:10.1111/ijcp.14480

PMID:34107147

Abstract

BACKGROUND

The current emergency medicine literature on cardioversion for atrial fibrillation (AF) describes its performance on those who are hemodynamically unstable, present within 48 hours of the onset of the arrhythmia, or are on long-term anticoagulants. For patients who are not anticoagulated and present with atrial fibrillation for more than 48 hours, one option is to perform a transesophageal echocardiogram and then synchronized cardioversion in the absence of atrial clot. The objective of this study is to compare outcomes of patients presenting to the emergency department (ED) with atrial fibrillation (AF) of more than 48 hours who underwent a transesophageal echocardiogram (TEE) and subsequent cardioversion in the ED versus the cardiology ward.

METHODS

This was a retrospective comparison study of patients who presented to the ED with AF for more than 48 hours, underwent a transesophageal echocardiogram, and then were electrically cardioverted either in the emergency department or in the cardiology ward. Outcomes include: time to cardioversion, length of hospital stay, rate of successful cardioversion, and rate of complications.

RESULTS

Electrical cardioversion was performed in the ED on 94 patients (62%) and the cardiology ward on 57 (38%). Over 90% of cardioversions were successful in both groups. Time to cardioversion was significantly less in the ED group versus the cardiology group (1.04 ± 0.9 days versus 3.81 ± 1.9; P < .001). Similarly, the mean length of hospital stay was less for the ED group (1.6 ± 1.6 days versus 7.3 ± 3.5; P < .001).

CONCLUSION

Patients who present in atrial fibrillation for more than 48 hours and then have a TEE undergo electrical cardioversion faster in the ED compared with the cardiology ward. This clinical pathway also results in a shorter length of hospital stay without having more side effects.

摘要

背景

目前关于心房颤动（AF）电复律的急诊医学文献描述了其在那些血流动力学不稳定、心律失常发作后 48 小时内出现或长期接受抗凝治疗的患者中的表现。对于未接受抗凝治疗且出现 AF 超过 48 小时的患者，一种选择是进行经食管超声心动图检查，然后在没有心房血栓的情况下进行同步电复律。本研究的目的是比较在急诊科（ED）就诊的 AF 超过 48 小时的患者进行经食管超声心动图（TEE）检查和随后在 ED 或心内科病房进行电复律的患者的结局。

方法

这是一项回顾性比较研究，纳入在 ED 就诊的 AF 超过 48 小时的患者，进行经食管超声心动图检查，然后在 ED 或心内科病房进行电复律。结局包括：电复律时间、住院时间、电复律成功率和并发症发生率。

结果

94 例（62%）患者在 ED 进行电复律，57 例（38%）患者在心内科病房进行电复律。两组中超过 90%的电复律是成功的。ED 组的电复律时间明显短于心内科组（1.04±0.9 天比 3.81±1.9 天；P<0.001）。同样，ED 组的平均住院时间也较短（1.6±1.6 天比 7.3±3.5 天；P<0.001）。