Área de Urgencias, Hospital Clínic de Barcelona, España.
Área de Urgencias, Hospital Clínic de Barcelona, España. Grup de Recerca Urgències, Processos i Patologies, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS). Unitat de Fibril·lació Auricular, Hospital Clínic de Barcelona, España.
Emergencias. 2024 Aug;36(4):263-270. doi: 10.55633/s3me/050.2024.
To explore the safety and effectiveness of electric cardioversion to treat atrial fibrillation in a hospital emergency department (ED).
Retrospective observational study in a hospital ED. We reviewed episodes of atrial fibrillation in patients aged 18 years orolder treated with cardioversion in our ED or referred for scheduling of cardioversion. Clinical outcome measures were conversion to sinus rhythm, immediate adverse effects (hypotension, arrythmia, or bronchial aspiration), revisiting within 90 days for atrial fibrillation, and complications (stroke, major bleeding, heart failure, or death). We studied factors associated with recurrence and adverse effects according to sex.
Cardioversion was used in 365 episodes (median patient age, 67 years); 38.6% were women. Cardioversion was applied in the ED in 75.1% of the episodes, and 24.9% were referred for scheduled cardioversion. Sinus rhythm was restored in 90.7% of the episodes. Emergency cardioversion was more effective than a scheduled procedure (odds ratio [OR], 4.258; 95% CI, 2.046-8.859; P < .001). No serious immediate adverse effects were reported, but 16.7% of the patients revisited for atrial fibrillation within 90 days. Factors associated with revisits were heart failure (hazard ratio [HR], 2.603; 95% CI, 1.298-5.222; P = .007), sleep apnea (HR, 2.598; 95% CI, 1.163-5.803; P = .020), and, in women, hypertension (HR, 3.706; 95% CI, 1.051-13.068; P = .042). Eleven patients developed late adverse events, including stroke (n = 2), major bleeding (n = 1), heart failure (n = 5), and death (n = 3).
Cardioversion is a useful, effective, and safe treatment for atrial fibrillation in the ED, although there are frequent recurrences. Factors associated with recurrence differ according to sex.
探讨在医院急诊科（ED）使用电复律治疗心房颤动的安全性和有效性。
这是一项在医院 ED 进行的回顾性观察性研究。我们对在我院 ED 接受电复律或转至 ED 进行电复律治疗的年龄在 18 岁及以上的心房颤动患者的发作情况进行了回顾，记录转复为窦性心律、即刻不良反应（低血压、心律失常或支气管吸入）、90 天内因心房颤动再访、以及并发症（卒、大出血、心力衰竭或死亡）等临床转归指标。我们根据性别研究了与复发和不良反应相关的因素。
共 365 例患者接受了电复律治疗（患者中位年龄 67 岁），其中 38.6%为女性。75.1%的患者在 ED 接受电复律，24.9%的患者转至 ED 进行计划电复律。90.7%的患者恢复窦性心律。急诊电复律比计划程序更有效（比值比 [OR]，4.258；95%置信区间 [CI]，2.046-8.859；P<.001）。没有报告严重的即刻不良反应，但 16.7%的患者在 90 天内因心房颤动再访。再发的相关因素有心衰（危险比 [HR]，2.603；95%CI，1.298-5.222；P=.007）、睡眠呼吸暂停（HR，2.598；95%CI，1.163-5.803；P=.020），以及女性患者中的高血压（HR，3.706；95%CI，1.051-13.068；P=.042）。11 例患者发生晚期不良事件，包括卒中（n=2）、大出血（n=1）、心力衰竭（n=5）和死亡（n=3）。
电复律是 ED 治疗心房颤动的一种有用、有效且安全的方法，但复发较为常见。与复发相关的因素因性别而异。
