Hengstman Geert, Saïd Salah A M, de Nooijer Ramon, Voorhorst Paul J M, van der Holst Frank H J, Kamphuis-Wolters Francisca F, Van Gelder Isabelle C, Crijns Harry J G M
Ambulance Oost, Hengelo, The Netherlands.
Department of Cardiology, Ziekenhuis Groep Twente, Hengelo, The Netherlands.
Neth Heart J. 2025 Sep;33(9):281-285. doi: 10.1007/s12471-025-01972-1. Epub 2025 Jul 31.
Hospital care shifted to home may contribute to sustainability of health care. It is uncertain if home-based electrical cardioversion (ECV) is feasible.
RACE‑6 is a prospective proof-of-concept pilot study on feasibility of ECV of persistent symptomatic atrial fibrillation (AF) at patient's homes. It is performed by a mobile nurse-led team, including an emergency care practitioner (ECP) and a sedation nurse, and is remotely supervised by a cardiologist with an ambulance (driver) standby. To ensure safe ECV, the ECP assessed the patients' homes beforehand for accessibility, hygiene, adequate space and light, electrical interference and explosive sources, electricity network stability, and the presence of an adequate informal caregiver overnight.
Six consenting patients with an uneventful previous in-hospital ECV for persistent AF developed one or two symptomatic recurrences and underwent in total 8 separate ECV attempts under conscious sedation at their homes. In all patients sinus rhythm returned and there were no early or late complications. Patients invariably preferred home cardioversion over cardioversion in-hospital.
Although applied in highly selected patients, home cardioversion may be extended to a wider selection of patients with persistent AF or even to patients with paroxysmal AF in need of acute restoration of sinus rhythm. Shortening time to cardioversion and early restoration of sinus rhythm may enhance patients' quality of life and postpone AF progression. Home cardioversion may appear safe and improve cost-effectiveness of care but randomized controlled trials are needed to show that home cardioversion may keep AF patients out of the hospital and contribute to the sustainability of health care.
Cardioversion at home is feasible and is generally well received by patients.
医院护理向家庭护理的转变可能有助于医疗保健的可持续性。基于家庭的电复律（ECV）是否可行尚不确定。
RACE-6是一项关于持续性症状性心房颤动（AF）患者在家中进行电复律可行性的前瞻性概念验证试点研究。该研究由一个由护士主导的移动团队进行，包括一名急救医生（ECP）和一名镇静护士，并由一名心脏病专家进行远程监督，同时有一辆救护车（司机）待命。为确保安全的电复律，急救医生事先评估患者家中的可达性、卫生状况、足够的空间和光线、电气干扰和爆炸源、电网稳定性以及是否有一名足够的非正式护理人员过夜。
6名之前在医院进行持续性房颤电复律过程顺利的患者出现了一到两次症状性复发，并在家中接受了总共8次在清醒镇静下的单独电复律尝试。所有患者均恢复窦性心律，且无早期或晚期并发症。患者始终更喜欢在家中进行电复律而非在医院进行。
尽管该研究应用于经过高度挑选的患者，但家庭电复律可能会扩展到更多持续性房颤患者，甚至扩展到需要急性恢复窦性心律的阵发性房颤患者。缩短电复律时间和早期恢复窦性心律可能会提高患者的生活质量并延缓房颤进展。家庭电复律可能看起来是安全的，并且能提高护理的成本效益，但需要随机对照试验来证明家庭电复律可以让房颤患者无需住院，并有助于医疗保健的可持续性。
在家中进行电复律是可行的，并且通常受到患者的欢迎。
