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Cardioversion of recent-onset atrial fibrillation and flutter in the emergency department

Year 2014, , 288 - 309, 27.06.2014

Osman Beton , Mehmet Yılmaz , Özge Korkmaz Öcal Berkan , İzzet Tandoğan

https://doi.org/10.7197/cmj.v36i2.1008002247

Abstract

Abstract

Atrial fibrillation (AF) is the most common arrhythmia encountered in acute medical practice. One-third of hospitalizations for cardiac rhythm disturbances are attributed to AF, with increasing rates in the past decade. Significant morbidity and mortality, including 15% to 20% of all ischemic strokes and 20% of all strokes, result from AF. The overall mortality rate for patients with AF is approximately double that for patients in normal sinus rhythm. Atrial flutter (AFL) has many clinical aspects that are similar to AF, AF and AFL have same management strategies in emergency settings. The major goals of treatment include alleviation of the associated symptoms and/or hemodynamic disturbance, reduction of the risk of systemic thromboembolism, reduction in hospital length of stay. The very large scaled AFFIRM and AF-CHF clinical trials compared rate and rhythm control (cardioversion), but did not explore the optimal management for recent-onset AF/AFL patients presenting to the emergency department (ED) with in 48 hours of symptoms. Although international standard guidelines are available, AF treatment in ED is still heterogeneous in terms of the management strategy (rate or rhythm) chosen. National based guidelines or consensus documents specific to ED management of AF has recently been developed and published in order to solve this problem. Aim of this review is to give detailed information for ED team about echocardiographic criterias supporting cardioversion (CV) of AF, CV procedure itself and new antiarrhythmic and oral anticoagulant drugs by adhering to the guidelines.

Keywords: Cardioversion, recent-onset atrial fibrillation, flutter, emergency

 

Özet

Atriyal fibrilasyon, akut tıbbi uygulamada karşılaşılan en sık aritmidir. Kalp ritm bozuklukları nedeniyle hastaneye yatanların üçte birinde neden AF olup son on yılda sıklığı giderek artmaktadır. AF belirgin mortalite ve morbiditeye neden olmaktadır. Tüm iskemik inmelerin %15-%20’si ve tüm inmelerin %20’si AF nedenlidir. AF’si olan hastalarda genel ölüm oranı, normal sinus ritmi olanlara göre yaklaşık iki kat fazladır. Atriyal flutter (AFL)’in AF’e benzer birçok klinik yönleri bulnumaktadır, acil durumlarda AF ve AFL aynı tedavi stratejilerine sahiptir. Tedavinin başlıca hedefleri, ilgili semptom ve/veya hemodinamik bozukluğun azaltılması, sistemik tromboembolik riskin azaltılması ve hastanede kalış süresinin kısaltılmasını içermektedir. Çok büyük ölçekli AFFIRM ve AF-CHF çalışmaları, hız ve ritim kontrolü (kardiyoversiyon) stratejilerini kıyasladı, fakat, semptom başlangıcının 48 saati içerisinde acile servise(AS) başvuran, yeni başlangıçlı AF/AFL hastalarında optimal tedavi yöntemini açığa kavuşturamadı. Uluslararası standart kılavuzlar bulunmasına rağmen AS’de AF tedavisi, seçilen tedavi stratejisi (hız veya ritim) yönünden hala heterojendir. Son zamanlarda bu sorunu çözmek amacıyla, AS’de AF tedavisine yönelik ulusal kaynaklı kılavuzlar ve konsensüs belgeleri geliştirilmiş ve yayınlanmıştır. Bu derlemenin amacı, AS ekibine, kılavuzlara bağlı kalınarak kardiyoversiyonu destekleyen ekokardiyografik parametreler, kardiyoversiyon işleminin kendisi ve yeni antiaritmik ve antikoagulan ilaçlar hakkında ayrıntılı bilgi sunmaktır.

Anahtar sözcükler: Kardiyoversiyon, atrial fibrilasyon, flutter, acil

Keywords

Cardioversion recent-onset atrial fibrillation flutter emergency

References

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  • Lip GY, Tean KN, Dunn FG. Treatment of atrial fibrillation in a district general hospital. Br Heart J 1994; 71: 92-5.
  • Stewart FM, Singh Y, Persson S. Atrial fibrillation: Prevalence and management in an acute general medical unit. Aust N Z J Med 1999; 29: 51-8.
  • Laguna P, Martín A, Del Arco, Gargantilla P, on behalf of the GEFAUR-1 investigators. Risk factors for stroke and thromboprophylaxis in atrial fibrillation: What happens in daily clinical practice? The GEFAUR-1 study. Ann Emerg Med 2004; 44: 3-11.
  • Fuster V, Ryden LE, Cannom DS. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation. J Am Coll Card 2006; 48: 1492
  • Camm AJ, Kirchhof P, Lip GYP. ESC 2010 guidelines for the management of patients with atrial fibrillation. Eur Heart J 2010; 31: 2369-429.
  • Gillis AM, Verma A, Talajic M. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: Rate and rhythm management. Can J Cardiol 2011; 27: 47-59.
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  • Roy D, Talajic M, Nattel S. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 2008; 358: 2667-77.
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  • Siddoway LA. Amiodarone: Guidelines for use and monitoring. Am Fam Physician 2003; 68: 2189-97.
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  • Providência R, Bara S, Paiva L. The role of echocardiography as a predictor of the incidence and progression of atrial fibrillation. J Atr Fibrillation 2012; 5: 27
  • Marchese P, Malavasi V, Rossi L. Indexed left atrial volume is superior to left atrial diameter in predicting nonvalvular atrial fibrillation recurrence after successful cardioversion: A prospective study. Echocardiography 2012; 29: 276
  • Frick M, Frykman V, Jensen-Urstad M. Factors predicting success rate and recurrence of atrial fibrillation after first electrical cardioversion in patients with persistent atrial fibrillation. Clinical Cardiology 2001; 24: 238-44.
  • Ben Khalfallah A, Sanaa I. Echocardiographic factors predictive of restoration and maintenance of sinus rhythm after reduction of atrial fibrillation. Arch Mal Coeur Vaiss 2007; 100: 745-52.
  • Antonielli E, Pizzuti A, Pálinkás A. Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation. J Am Coll Cardiol 2002; 39: 1443-9.
  • Okçün B, Yigit Z, Küçükoglu MS, Mutlu H, Sansoy V, Güzelsoy D, Uner S. Predictors for maintenance of sinus rhythm after cardioversion in patients with nonvalvular atrial fibrillation. Echocardiography 2002; 19: 351-7.
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  • Wakai A, O'Neill JO. Emergency management of atrial fibrillation. Postgrad Med J 2003; 79: 313-9.
  • Fuster V, Rydén LE, Asinger RW. ACC/AHA/ESCguidelines for the management of patients with atrial fibrillation. Eur Heart J 2001; 22: 1852-923.
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Acil serviste yeni başlangıçlı atriyal fibrilasyon ve flutter kardiyoversiyonu

Year 2014, , 288 - 309, 27.06.2014

Osman Beton , Mehmet Yılmaz , Özge Korkmaz Öcal Berkan , İzzet Tandoğan

https://doi.org/10.7197/cmj.v36i2.1008002247

Abstract

Atriyal fibrilasyon, akut tıbbi uygulamada karşılaşılan en sık aritmidir. Kalp ritm bozuklukları nedeniyle hastaneye yatanların üçte birinde neden AF olup son on yılda sıklığı giderek artmaktadır. AF belirgin mortalite ve morbiditeye neden olmaktadır. Tüm iskemik inmelerin %15%20’si ve tüm inmelerin %20’si AF nedenlidir. AF’si olan hastalarda genel ölüm oranı, normal sinus ritmi olanlara göre yaklaşık iki kat fazladır. Atriyal flutter (AFL)’in AF’e benzer birçok klinik yönleri bulnumaktadır, acil durumlarda AF ve AFL aynı tedavi stratejilerine sahiptir. Tedavinin başlıca hedefleri, ilgili semptom ve/veya hemodinamik bozukluğun azaltılması, sistemik tromboembolik riskin azaltılması ve hastanede kalış süresinin kısaltılmasını içermektedir. Çok büyük ölçekli AFFIRM ve AF-CHF çalışmaları, hız ve ritim kontrolü (kardiyoversiyon) stratejilerini kıyasladı, fakat, semptom başlangıcının 48 saati içerisinde acile servise(AS) başvuran, yeni başlangıçlı AF/AFL hastalarında optimal tedavi yöntemini açığa kavuşturamadı. Uluslararası standart kılavuzlar bulunmasına rağmen AS’de AF tedavisi, seçilen tedavi stratejisi (hız veya ritim) yönünden hala heterojendir. Son zamanlarda bu sorunu çözmek amacıyla, AS’de AF tedavisine yönelik ulusal kaynaklı kılavuzlar ve konsensüs belgeleri geliştirilmiş ve yayınlanmıştır. Bu derlemenin amacı, AS ekibine, kılavuzlara bağlı kalınarak kardiyoversiyonu destekleyen ekokardiyografik parametreler, kardiyoversiyon işleminin kendisi ve yeni antiaritmik ve antikoagulan ilaçlar hakkında ayrıntılı bilgi sunmaktır.

Keywords

Kardiyoversiyon atrial fibrilasyon flutter acil

References

  • Zarifis J, Beevers G, Lip GY. Acute admissions with atrial fibrillation in a British multiracial hospital population. Br J Clin Pract 1997; 51: 91-6.
  • Lip GY, Tean KN, Dunn FG. Treatment of atrial fibrillation in a district general hospital. Br Heart J 1994; 71: 92-5.
  • Stewart FM, Singh Y, Persson S. Atrial fibrillation: Prevalence and management in an acute general medical unit. Aust N Z J Med 1999; 29: 51-8.
  • Laguna P, Martín A, Del Arco, Gargantilla P, on behalf of the GEFAUR-1 investigators. Risk factors for stroke and thromboprophylaxis in atrial fibrillation: What happens in daily clinical practice? The GEFAUR-1 study. Ann Emerg Med 2004; 44: 3-11.
  • Fuster V, Ryden LE, Cannom DS. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation. J Am Coll Card 2006; 48: 1492
  • Camm AJ, Kirchhof P, Lip GYP. ESC 2010 guidelines for the management of patients with atrial fibrillation. Eur Heart J 2010; 31: 2369-429.
  • Gillis AM, Verma A, Talajic M. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: Rate and rhythm management. Can J Cardiol 2011; 27: 47-59.
  • The National collaborating centre for chronic conditions. Atrial fibrillation: National clinical guideline for management in primary and secondary care. London: Royal College of Physicians (UK); 2006: www.nice.org.uk (Erişim tarihi: 21. 05. 2014).
  • Wyse DG, Waldo AL, DiMarco JP. Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002; 347: 1825
  • Roy D, Talajic M, Nattel S. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 2008; 358: 2667-77.
  • Buccelletti F, Di Somma S, Galante A. Disparities in management of new-onset atrial fibrillation in the emergency department despite adherence to the current guidelines: Data from a large metropolitan area. Intern Emerg Med 2011; 6: 149
  • Rogenstein C, Kelly AM, Mason S. An international view of how recent-onset atrial fibrillation is treated in the emergency department. Acad Emerg Med 2012; 19: 1255-60.
  • Stiell IG, Clement CM, Brison RJ. Variation in management of recent-onset atrial fibrillation and flutter among academic hospital emergency departments. Ann Emerg Med 2011; 57: 13-21. delArco C, Martín A, Laguna P. Investigators in the Spanish Atrial Fibrillation in Emergency Medicine Study Group (GEFAUR). Analysis of current management of atrial fibrillation in the acute setting: GEFAUR-1 study. Ann Emerg Med 2005; 46: 424-30.
  • Zimetbaum P, Ho KK, Olshansky B. Variation in the utilization of antiarrhythmic drugs in patients with new-onset atrial fibrillation. Am J Cardiol 2003; 91: 81-3.
  • Laguna P, Martín A, Del Arco C. Spanish Atrial Fibrillation in Emergency Medicine Study Group (GEFAUR-2). Differences among clinical classification schemes for predicting stroke in atrial fibrillation: Implications for therapy in daily practice. Acad Emerg Med 2005; 12: 828-34.
  • Arendts G, Krishnaraj M, Paull G, Rees D. Management of atrial fibrillation in the acute setting-findings from an Australasian survey. Heart Lung Circ 2010; 19: 423Stiell IG, Macle L; CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: Management of recentonset atrial fibrillation and flutter in the emergency department. Can J Cardiol 2011; 27: 38-46.
  • Martinez AM, Lozano IF, Puig BCV. Atrial fibrillation management in the hospital emergency department: 2012 update. Emergencias 2012; 24: 300-324.
  • Camm AJ, Lip GY, De Caterina R. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2012; 33: 2719-47.
  • Vahanian A, Alfieri O, Andreotti F. Guidelines on the management of valvular heart disease (version 2012): Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2012; 33: 2451
  • Bonow RO, Carabello BA, Chatterjee K. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2008; 118: 523-661.
  • Sohara H, Amitani S, Kurose M, Miyahara K. Atrial fibrillation activates platelets and coagulation in a time-dependent manner: A study in patients with paroxismal atrial fibrillation. J Am Coll Cardiol 1997; 29: 106-12.
  • Sparks PB, Jayaprakash S. Left atrial mechanical function after brief duration atrial fibrillation. J Am Coll Cardiol 1999; 33: 342-9.
  • Choi JI, Park SM, Park JS. Changes in left atrial structure and function after catheter ablation and electrical cardioversion for atrial fibrillation Circ J. 2008; 72: 2051-7.
  • Wakai A, O'Neill JO. Emergency management of atrial fibrillation. Postgrad Med J. 2003; 79: 313-9.
  • Whitbeck MG, Charnigo RJ, Khairy P. Increased mortality among patients taking digoxin-analysis from the AFFIRM study. Eur Heart J 2012: 10; 1093.
  • Siddoway LA. Amiodarone: Guidelines for use and monitoring. Am Fam Physician 2003; 68: 2189-97.
  • Marchese P, Bursi F, Delle Donne G. Indexed left atrial volume predicts the recurrence of non-valvular atrial fibrillation after successful cardioversion. Eur J Echocardiogr 2011; 12: 214-21.
  • Providência R, Bara S, Paiva L. The role of echocardiography as a predictor of the incidence and progression of atrial fibrillation. J Atr Fibrillation 2012; 5: 27
  • Marchese P, Malavasi V, Rossi L. Indexed left atrial volume is superior to left atrial diameter in predicting nonvalvular atrial fibrillation recurrence after successful cardioversion: A prospective study. Echocardiography 2012; 29: 276
  • Frick M, Frykman V, Jensen-Urstad M. Factors predicting success rate and recurrence of atrial fibrillation after first electrical cardioversion in patients with persistent atrial fibrillation. Clinical Cardiology 2001; 24: 238-44.
  • Ben Khalfallah A, Sanaa I. Echocardiographic factors predictive of restoration and maintenance of sinus rhythm after reduction of atrial fibrillation. Arch Mal Coeur Vaiss 2007; 100: 745-52.
  • Antonielli E, Pizzuti A, Pálinkás A. Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation. J Am Coll Cardiol 2002; 39: 1443-9.
  • Okçün B, Yigit Z, Küçükoglu MS, Mutlu H, Sansoy V, Güzelsoy D, Uner S. Predictors for maintenance of sinus rhythm after cardioversion in patients with nonvalvular atrial fibrillation. Echocardiography 2002; 19: 351-7.
  • Wang T, Wang M, Fung JW, Yip. Atrial strain rate echocardiography can predict success or failure of cardioversion for atrial fibrillation: A combined transthoracic tissue Doppler and transoesophageal imaging study. Int J Cardiol 2007; 114: 202-9.
  • Lucà F, LaMeir M, Rao CM. Pharmacological management of atrial fibrillation: One, none, one hundred thousand. Cardiol Res Pract 2011; 874802.
  • Nair M, George LK, Kosby SKG. Safety and efficacy of ibutilide in cardioversion of atrial flutter and fibrillation. J Am Board Fam Med 2011; 24: 86
  • Bronis K, Metaxa S, Koulouris S, Manolis AS. Vernakalant: Review of a novel atrial selective antiarrhythmic agent and its place in current treatment of atrial fibrillation. Hospital chronicles 2012; 7: 171-81.
  • Wakai A, O'Neill JO. Emergency management of atrial fibrillation. Postgrad Med J 2003; 79: 313-9.
  • Fuster V, Rydén LE, Asinger RW. ACC/AHA/ESCguidelines for the management of patients with atrial fibrillation. Eur Heart J 2001; 22: 1852-923.
  • Charles DD. European resuscitation council guidelines for resuscitation 2010, Section 4: Adult advanced life support. Resuscitation 2010; 81: 1305-52.
  • Nolan JP. European resuscitation council guidelines for resuscitation 2010, Section 1: Executive summary. Resuscitation 2010; 81: 1219-76.
  • Pitcher D, Perkins G. Peri-arrest arrhythmias. In: Nolan JP, ed. Resuscitation guidelines 2010.1st ed. London: Resuscitation Council 2010; 81-9.
  • Deakin C, Nolan J, Perkins G, Lockey A. Adult advanced life support. In: Nolan JP, ed. Resuscitation guidelines 2010.1st ed. London: Resuscitation Council 2010; 58-80.
  • Morrison LJ. Part 8: Advanced life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2010; 122: 345-421.
  • Wann LS, Curtis AB, January CT. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 123: 104-23.
  • Gallagher MM, Guo XH, Poloniecki JD. Initial energy sitting, outcome and efficiency in direct current cardioversion of atrial fibrillation. J Am Coll Cardiol 2001; 38: 1498-504.
  • Lundstrom T, Ryden L. Chronic atrial fibrillation: Long term results of direct current cardioversion. Acta Med Scand 1988; 223: 53-9.
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There are 71 citations in total.

Details

Primary Language English
Journal Section Reviews
Authors

Osman Beton

Mehmet Yılmaz

Özge Korkmaz

Öcal Berkan

İzzet Tandoğan

Publication Date June 27, 2014
Published in Issue Year 2014

Cite

AMA Beton O, Yılmaz M, Korkmaz Ö, Berkan Ö, Tandoğan İ. Cardioversion of recent-onset atrial fibrillation and flutter in the emergency department. CMJ. June 2014;36(2):288-309. doi:10.7197/cmj.v36i2.1008002247