Atrial fibrillation (AF) is the most common arrhythmia in the world, and its management relies on restoring sinus rhythm through external electrical shock and controlling the heart rate. This procedure should be perfo...Atrial fibrillation (AF) is the most common arrhythmia in the world, and its management relies on restoring sinus rhythm through external electrical shock and controlling the heart rate. This procedure should be performed under sedation with strict monitoring of blood pressure and saturation after the elimination of thrombus in the left atrium. Objective: The aim of this article is to provide an overview of the impact of anticoagulation and imaging in the periprocedural period, the modalities, and the complications associated with electrical cardioversion (ECV). Research Method: A review of recent literature was conducted using medical databases such as PubMed and Scopus. Searches were performed on articles published between 2003 and 2024, focusing on the new ESC guidelines for 2024. The keywords used included “electrical cardioversion”, “atrial fibrillation”, “orthogonal cardioversion” and “anticoagulation”. Inclusion criteria encompassed clinical trials, meta-analyses, and literature reviews, while studies addressing other treatment forms for AF or lacking information on ECV were excluded. Relevant data were extracted and synthesized to provide an overview of the modalities and complications related to ECV in the context of AF. Results and Conclusion: The use of high-energy biphasic shocks significantly improves rhythm control success and also reduces the incidence of ventricular fibrillation. Furthermore, orthogonal electrical cardioversion (OECV) has proven effective for cases of AF refractory to standard protocols, allowing for a lower defibrillation threshold and promoting better current distribution. However, complications must be considered, particularly thromboembolic events in non-anticoagulated patients. Other complications, such as bradycardia and recurrence of AF, may arise post-procedure. It is therefore crucial to ensure adequate anticoagulation before and after ECV, as well as continuous monitoring, to minimize these risks and optimize clinical outcomes.展开更多
BACKGROUND: Atrial fibrillation(AF) is the most common arrhythmia treated in the emergency department(ED), with primary electrical cardioversion(PEC) the preferred method of rhythm control. Anecdotally, patients under...BACKGROUND: Atrial fibrillation(AF) is the most common arrhythmia treated in the emergency department(ED), with primary electrical cardioversion(PEC) the preferred method of rhythm control. Anecdotally, patients undergoing ED procedural sedation(EDPS) for PEC differ from those requiring EDPS for other procedures: they are at higher risk of adverse events, and require fewer drugs and lower doses. We attempt to verify this using an EDPS registry at a Canadian, tertiary care teaching hospital.METHODS: This is a retrospective review of patients that underwent EDPS for the period of June 2006 to September 2014. We compared demographics, medication use and intra-procedural adverse events between those receiving EDPS for PEC for AF compared to that for other indications. We report the asssociation between AEs and predictors using logistic regression.RESULTS: A total of 4 867 patients were included, 714 for PEC for AF and 4 153 for other indications. PEC patients were more likely male(58.5% vs. 47.1%), older(59.5 years vs. 48.1 years), and less likely to be ASA I(46.6% vs. 69.0%). PEC patients received smaller doses of propofol and less likely to receive adjuvant analgesic therapy(11.5% vs. 78.2%). PEC patients were more likely to experience hypotension(27.6% vs. 16.5%) but respiratory AEs(apnea, hypoxia and airway intervention) were not different.CONCLUSION: EDPS for PEC differs from that conducted for other purposes: patients tend to be less healthy, receive smaller doses of medication and more likely to suffer hypotension without an increase in respiratory AEs. These factors should be considered when performing EDPS.展开更多
Dear editor, We read with pleasure the well-designed study by Butler et al of electrical cardioversion of emergency department patients with atrial fibrillation. We appreciate their analysis of the distinctives of pro...Dear editor, We read with pleasure the well-designed study by Butler et al of electrical cardioversion of emergency department patients with atrial fibrillation. We appreciate their analysis of the distinctives of procedural sedation when employed for this indication. Understanding the dosing adjustments to propofol undertaken by their sedationists will help us more carefully evaluate our own approach to sedating patients undergoing electrical cardioversion of atrial fibrillation.展开更多
Background and aims:Immediate recurrence(Im-Recurr),a type of atrial fibrillation(AF)recurrence occurring during the blanking period after radiofrequency catheter ablation(RFCA),has received little attention.Therefore...Background and aims:Immediate recurrence(Im-Recurr),a type of atrial fibrillation(AF)recurrence occurring during the blanking period after radiofrequency catheter ablation(RFCA),has received little attention.Therefore,this study was aimed at exploring the clinical significance of Im-Recurr in patients with AF after RFCA.Methods:This study retrospectively included patients with AF who underwent RFCA at our center.Regression,propensity score matching(PSM),and survival curve analyses were conducted to investigate the effects of Im-Recurr on costs,hospitalization durations,AF recurrence rates,and predictors of Im-Recurr.Results:A total of 898 patients were included,among whom 128 developed Im-Recurr after RFCA.Multiple linear regression analysis revealed that Im-Recurr correlated with greater cost,hospitalization duration,and hospitalization duration after ablation.Logistic regression and PSM analyses indicated that intraoperative electric cardioversion(IEC)was an independent predictor of Im-Recurr.The follow-up results suggested a significantly higher 1-year cumulative AF recurrence rate in the Im-Recurr group than the control group.Conclusions:Im-Recurr significantly increases the cost and length of hospitalization for patients with AF undergoing RFCA and is associated with an elevated 1-year cumulative AF recurrence rate.IEC serves as an independent predictor of Im-Recurr.Registration number:ChiCTR2200065235.展开更多
Atrial fibrillation(AF)is the most common arrhythmia in the elderly and its incidence increases with aging.[1]Electrical cardioversion is used as a strategy for rhythm control in patients with supraventricular arrhyth...Atrial fibrillation(AF)is the most common arrhythmia in the elderly and its incidence increases with aging.[1]Electrical cardioversion is used as a strategy for rhythm control in patients with supraventricular arrhythmias.In octagenarians,there are challenges associated with the indication for electrical cardioversion,such as the use of appropriate sedation and anticoagulant agents.Most decisions in clinical practice for these patients derive from observational data and personal experience,since octagenarians represent a minority of patients included in randomized clinical trials.Little evidence is available regarding the clinical context of electrical cardioversion in this vulnerable population.Therefore,we aimed to describe the clinical profile of octagenarians undergoing electrical cardioversion in a cardiology reference center from 2014 to 2018.展开更多
Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P ...Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.展开更多
文摘Atrial fibrillation (AF) is the most common arrhythmia in the world, and its management relies on restoring sinus rhythm through external electrical shock and controlling the heart rate. This procedure should be performed under sedation with strict monitoring of blood pressure and saturation after the elimination of thrombus in the left atrium. Objective: The aim of this article is to provide an overview of the impact of anticoagulation and imaging in the periprocedural period, the modalities, and the complications associated with electrical cardioversion (ECV). Research Method: A review of recent literature was conducted using medical databases such as PubMed and Scopus. Searches were performed on articles published between 2003 and 2024, focusing on the new ESC guidelines for 2024. The keywords used included “electrical cardioversion”, “atrial fibrillation”, “orthogonal cardioversion” and “anticoagulation”. Inclusion criteria encompassed clinical trials, meta-analyses, and literature reviews, while studies addressing other treatment forms for AF or lacking information on ECV were excluded. Relevant data were extracted and synthesized to provide an overview of the modalities and complications related to ECV in the context of AF. Results and Conclusion: The use of high-energy biphasic shocks significantly improves rhythm control success and also reduces the incidence of ventricular fibrillation. Furthermore, orthogonal electrical cardioversion (OECV) has proven effective for cases of AF refractory to standard protocols, allowing for a lower defibrillation threshold and promoting better current distribution. However, complications must be considered, particularly thromboembolic events in non-anticoagulated patients. Other complications, such as bradycardia and recurrence of AF, may arise post-procedure. It is therefore crucial to ensure adequate anticoagulation before and after ECV, as well as continuous monitoring, to minimize these risks and optimize clinical outcomes.
文摘BACKGROUND: Atrial fibrillation(AF) is the most common arrhythmia treated in the emergency department(ED), with primary electrical cardioversion(PEC) the preferred method of rhythm control. Anecdotally, patients undergoing ED procedural sedation(EDPS) for PEC differ from those requiring EDPS for other procedures: they are at higher risk of adverse events, and require fewer drugs and lower doses. We attempt to verify this using an EDPS registry at a Canadian, tertiary care teaching hospital.METHODS: This is a retrospective review of patients that underwent EDPS for the period of June 2006 to September 2014. We compared demographics, medication use and intra-procedural adverse events between those receiving EDPS for PEC for AF compared to that for other indications. We report the asssociation between AEs and predictors using logistic regression.RESULTS: A total of 4 867 patients were included, 714 for PEC for AF and 4 153 for other indications. PEC patients were more likely male(58.5% vs. 47.1%), older(59.5 years vs. 48.1 years), and less likely to be ASA I(46.6% vs. 69.0%). PEC patients received smaller doses of propofol and less likely to receive adjuvant analgesic therapy(11.5% vs. 78.2%). PEC patients were more likely to experience hypotension(27.6% vs. 16.5%) but respiratory AEs(apnea, hypoxia and airway intervention) were not different.CONCLUSION: EDPS for PEC differs from that conducted for other purposes: patients tend to be less healthy, receive smaller doses of medication and more likely to suffer hypotension without an increase in respiratory AEs. These factors should be considered when performing EDPS.
文摘Dear editor, We read with pleasure the well-designed study by Butler et al of electrical cardioversion of emergency department patients with atrial fibrillation. We appreciate their analysis of the distinctives of procedural sedation when employed for this indication. Understanding the dosing adjustments to propofol undertaken by their sedationists will help us more carefully evaluate our own approach to sedating patients undergoing electrical cardioversion of atrial fibrillation.
基金supported by the China Postdoctoral Science Foundation(2021M702833 and 2022M712764)the National Natural Science Foundation of China(82070409)the Research Fund of Health Agency of Zhejiang Province(2023RC163).
文摘Background and aims:Immediate recurrence(Im-Recurr),a type of atrial fibrillation(AF)recurrence occurring during the blanking period after radiofrequency catheter ablation(RFCA),has received little attention.Therefore,this study was aimed at exploring the clinical significance of Im-Recurr in patients with AF after RFCA.Methods:This study retrospectively included patients with AF who underwent RFCA at our center.Regression,propensity score matching(PSM),and survival curve analyses were conducted to investigate the effects of Im-Recurr on costs,hospitalization durations,AF recurrence rates,and predictors of Im-Recurr.Results:A total of 898 patients were included,among whom 128 developed Im-Recurr after RFCA.Multiple linear regression analysis revealed that Im-Recurr correlated with greater cost,hospitalization duration,and hospitalization duration after ablation.Logistic regression and PSM analyses indicated that intraoperative electric cardioversion(IEC)was an independent predictor of Im-Recurr.The follow-up results suggested a significantly higher 1-year cumulative AF recurrence rate in the Im-Recurr group than the control group.Conclusions:Im-Recurr significantly increases the cost and length of hospitalization for patients with AF undergoing RFCA and is associated with an elevated 1-year cumulative AF recurrence rate.IEC serves as an independent predictor of Im-Recurr.Registration number:ChiCTR2200065235.
文摘Atrial fibrillation(AF)is the most common arrhythmia in the elderly and its incidence increases with aging.[1]Electrical cardioversion is used as a strategy for rhythm control in patients with supraventricular arrhythmias.In octagenarians,there are challenges associated with the indication for electrical cardioversion,such as the use of appropriate sedation and anticoagulant agents.Most decisions in clinical practice for these patients derive from observational data and personal experience,since octagenarians represent a minority of patients included in randomized clinical trials.Little evidence is available regarding the clinical context of electrical cardioversion in this vulnerable population.Therefore,we aimed to describe the clinical profile of octagenarians undergoing electrical cardioversion in a cardiology reference center from 2014 to 2018.
基金funded in part by the Coordination of Improvement of Higher Level Personnel—Brazil(CAPES)—Finance Code 001 by the National Council of Scientific and Technological Development—Brazil(CNPq)—Doctorate GDby Research Foundation of the State of Rio Grande do Sul(FAPERGS).
文摘Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.
