Cardioversion of Recent-Onset Paroxysmal Atrial Fibrillation to Sinus Rhythm in the Emergency Department: Comparison of Intravenous Drugs
Atrial fibrillation is the most common clinically significant arrhythmia encountered in the emergency department, occurring in 0.4% of the general population and in up to 5% of people older than 60 years . Knowledge of the underlying heart disease is helpful in the critical evaluation and management of patients with atrial fibrillation. Coronary artery disease, cardiomyopathy, valvular disease, some kinds of congenital heart disease, hypertensive cardiovascular disease, and heart failure may all lead to atrial fibrillation. Occult or manifest thyreotoxicosis, alcohol abuse, and pulmonary embolism should be considered too, in patients with new-onset atrial fibrillation. The prognosis and treatment options of this arrhythmia may vary in these conditions, especially in patients who present new-onset arrhythmia [1, 2]. Loss of atrial contraction is not well tolerated by patients with impaired diastolic function or in the presence of systolic dysfunction, with hemodynamic consequences. Atrial fibrillation occurring in otherwise normal hearts or in the absence of an identifiable cause is called lone atrial fibrillation [3-6]. In critically ill patients the development of atrial fibrillation is often associated with significant hemodynamic impairment, generating the need for urgent cardioversion and the correction of treatable precipitating factors. When acute atrial fibrillation is associated with severe hemodynamic deterioration, electrical cardioversion is the treatment of choice. Electrical cardioversion is indicated when the ventricular response is greater than 130 beats/min in association with hypotension, an index of inadequate tissue perfusion. In a less urgent situation a less aggressive strategy and drug therapy can be considered [7-10]. Because systemic embolism is a complication of atrial fibrillation, electrical or drug-induced cardioversion can be performed without preceding anticoagulation up to 48 h after the onset of atrial fibrillation; when atrial fibrillation has started more than 2 days before, or its
KeywordsAtrial Fibrillation Sinus Rhythm Antiarrhythmic Drug Electrical Cardioversion Sick Sinus Syndrome
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