Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-24T17:30:21.040Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of rate control medication before cardioversion of recent-onset atrial fibrillation or flutter in the emergency department is associated with reduced success rates

Published online by Cambridge University Press:  11 May 2015

Gabriel E. Blecher ,
Ian G. Stiell ,
Brian H. Rowe ,
Eddy Lang ,
Robert J. Brison ,
Jeffrey J. Perry ,
Catherine M. Clement ,
Bjug Borgundvaag ,
Trevor Langhan  and
Kirk Magee
...Show all authors
Gabriel E. Blecher*
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, ON
Ian G. Stiell
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, ON
Brian H. Rowe
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, AB
Eddy Lang
Affiliation:
Division of Emergency Medicine, University of Calgary, Calgary, AB
Robert J. Brison
Affiliation:
Department of Emergency Medicine, Queen's University, Kingston, ON
Jeffrey J. Perry
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, ON
Catherine M. Clement
Affiliation:
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
Bjug Borgundvaag
Affiliation:
Division of Emergency Medicine, University of Toronto, Toronto, ON
Trevor Langhan
Affiliation:
Department of Emergency Medicine, Queen's University, Kingston, ON
Kirk Magee
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
Rob Stenstrom
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, BC
David Birnie
Affiliation:
University of Ottawa Heart Institute, University of Ottawa, Ottawa
George A. Wells
Affiliation:
University of Ottawa Heart Institute, University of Ottawa, Ottawa
*
Clinical Epidemiology Unit, F663, Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y 4E9; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

It is believed that when patients present to the emergency department (ED) with recent-onset atrial fibrillation or flutter (RAFF), controlling the ventricular rate before cardioversion improves the success rate. We evaluated the influence of rate control medication and other variables on the success of cardioversion.

Methods:

This secondary analysis of a medical records review comprised 1,068 patients with RAFF who presented to eight Canadian EDs over 12 months. Univariate analysis was performed to find associations between predictors of conversion to sinus rhythm including use of rate control, rhythm control, and other variables. Predictive variables were incorporated into the multivariate model to calculate adjusted odds ratios (ORs) associated with successful cardioversion.

Results:

A total of 634 patients underwent attempted cardioversion: 428 electrical, 354 chemical, and 148 both. Adjusted ORs for factors associated with successful electrical cardioversion were use of rate control medication, 0.39 (95% confidence interval [CI] 0.21-0.74); rhythm control medication, 0.28 (95% CI 0.15-0.53); and CHADS2 score > 0, 0.43 (95% CI 0.15-0.83). ORs for factors associated with successful chemical cardioversion were use of rate control medication, 1.29 (95% CI 0.82-2.03); female sex, 2.37 (95% CI 1.50-3.72); and use of procainamide, 2.32 (95% CI 1.43-3.74).

Conclusion:

We demonstrated reduced successful electrical cardioversion of RAFF when patients were pretreated with either rate or rhythm control medication. Although rate control medication was not associated with increased success of chemical cardioversion, use of procainamide was. Slowing the ventricular rate prior to cardioversion should be avoided.

Keywords

atrial fibrillationcardioversionrate control
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 3 , March 2012 , pp. 169 - 177
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

References

REFERENCES

1.Feinberg, WM, Blackshear, JL, Laupacis, A, et al. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med 1995;155:469–73, doi:10.1001/archinte.1995.00430050045005.CrossRefGoogle ScholarPubMed
2.Raitt, MH, Volgman, AS, Zoble, RG, et al. Prediction of the recurrence of atrial fibrillation after cardioversion in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J 2006;151:390–6, doi:10.1016/j.ahj.2005.03.019.Google Scholar
3.Roy, D, Talajic, M, Nattel, S, et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 2008;358:2667–77, doi:10.1056/NEJMoa0708789.Google Scholar
4.Stiell, IG, Clement, CM, Brison, RJ, et al. Variation in management of recent-onset atrial fibrillation and flutter among academic hospital emergency departments. Ann Emerg Med, 201157:13–21.Google Scholar
5.Fuster, V, Ryden, LE, Cannom, DS, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006;114:e257–354, doi:10.1161/CIRCULATIONAHA.106.177292.Google Scholar
6.Blich, M, Edoute, Y. Electrical cardioversion for persistent or chronic atrial fibrillation: outcome and clinical factors predicting short and long term success rate. Int J Cardiol 2006;107:389–94, doi:10.1016/j.ijcard.2005.03.057.Google Scholar
7.Reiffel, JA. Cardioversion for atrial fibrillation: treatment options and advances. Pacing Clin Electrophysiol 2009;32:1073–84, doi:10.1111/j.1540-8159.2009.02441.x.Google Scholar
8.Hagens, VE, Crijns, HJ, Van Veldhuisen, DJ, et al. Rate control versus rhythm control for patients with persistent atrial fibrillation with mild to moderate heart failure: results from the RAte Control versus Electrical cardioversion (RACE) study. Am Heart J 2005;149:1106–11, doi:10.1016/j.ahj.2004.11.030.CrossRefGoogle ScholarPubMed
9.Yealy, D, Delbridge, T. Dysrhythmias. In: Marx, J, Hockberger, R, Walls, R, et al, editors, Rosen’s emergency medicine: concepts and clinical practice. 7th ed. Philadelphia: Mosby Elsevier; 2010. p. 984–1024.Google Scholar
10.Hosmer, DW, Hosmer, T, Le Cessie, S, Lemeshow, S. A comparison of goodness-of-fit tests for the logistic regression model. Stat Med 1997;16:965–80, doi:10.1002/(SICI)1097-0258(19970515)16:9<965::AID-SIM509>3.0.CO;2-O.Google Scholar
11.Fragakis, N, Bikias, A, Delithanasis, I, et al. Acute betaadrenoceptor blockade improves efficacy of ibutilide in conversion of atrial fibrillation with a rapid ventricular rate. Europace 2009;11:70–4, doi:10.1093/europace/eun302.CrossRefGoogle ScholarPubMed
12.Vijayalakshmi, K, Whittaker, VJ, Sutton, A, et al. A randomized trial of prophylactic antiarrhythmic agents (amiodarone and sotalol) in patients with atrial fibrillation for whom direct current cardioversion is planned. Am Heart J 2006;151:863.e1-e6, doi:10.1016/j.ahj.2005.09.009.Google Scholar
13.Channer, KS, Birchall, A, Steeds, RP, et al. A randomized placebo-controlled trial of pre-treatment and short- or long-term maintenance therapy with amiodarone supporting DC cardioversion for persistent atrial fibrillation. Eur Heart J 2004;25:144–50, doi:10.1016/j.ehj.2003.10.020.Google Scholar
14.Ergene, U, Ergene, O, Cete, Y, et al. Predictors of success in the conversion of new-onset atrial fibrillation using oral propafenone. Eur J Emerg Med 1998;5:425–8, doi:10.1097/00063110-199812000-00008.Google Scholar
15.Bianconi, L, Boccadamo, R, Pappalardo, A, et al. Effectiveness of intravenous propafenone for conversion of atrial fibrillation and flutter of recent onset. Am J Cardiol 1989;64:335–8, doi:10.1016/0002-9149(89)90530-4.Google Scholar
16.Joseph, AP, Ward, MR. A prospective, randomized controlled trial comparing the efficacy and safety of sotalol, amiodarone, and digoxin for the reversion of new-onset atrial fibrillation. Ann Emerg Med 2000;36:1–9, doi:10.1067/mem.2000.107655.Google Scholar
17.Rostagno, C, Bacci, F, Paladini, B, et al. Predictors of successful at-home chemical cardioversion in new-onset atrial fibrillation. Eur J Emerg Med 1994;1:131–5.Google Scholar
18.Stiell, IG, Clement, CM, Perry, JJ, et al. Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter. CJEM 2010;12:181–91.Google Scholar
19.Martinez-Marcos, FJ, Garcia-Garmendia, JL, Ortega-Carpio, A, et al. Comparison of intravenous flecainide, propafenone, and amiodarone for conversion of acute atrial fibrillation to sinus rhythm. Am J Cardiol 2000;86:950–3, doi:10.1016/S0002-9149(00)01128-0.CrossRefGoogle ScholarPubMed
20.Tijunelis, MA, Herbert, ME. Myth: Intravenous amiodarone is safe in patients with atrial fibrillation and Wolff-Parkinson-White syndrome in the emergency department. CJEM 2005;7:262–5.Google Scholar
21.Hilleman, DE, Spinler, SA. Conversion of recent-onset atrial fibrillation with intravenous amiodarone: a meta-analysis of randomized controlled trials. Pharmacotherapy 2002;22:66–74, doi:10.1592/phco.22.1.66.33492.Google Scholar
22.Chevalier, P, Durand-Dubief, A, Burri, H, et al. Amiodarone versus placebo and class Ic drugs for cardioversion of recentonset atrial fibrillation: a meta-analysis. J Am Coll Cardiol 2003;41:255’62, doi:10.1016/S0735-1097(02)02705-5.CrossRefGoogle ScholarPubMed
23.Letelier, LM, Udol, K, Ena, J, et al. Effectiveness of amiodarone for conversion of atrial fibrillation to sinus rhythm: a meta-analysis. Arch Intern Med 2003;163:777–85, doi:10.1001/archinte.163.7.777.CrossRefGoogle ScholarPubMed
24.Miller, MR, McNamara, RL, Segal, JB, et al. Efficacy of agents for pharmacologic conversion of atrial fibrillation and subsequent maintenance of sinus rhythm: a meta-analysis of clinical trials. J Fam Pract 2000;49:1033–46.Google Scholar
25.Thomas, SP, Guy, D, Wallace, E, et al. Rapid loading of sotalol or amiodarone for management of recent onset symptomatic atrial fibrillation: a randomized, digoxincontrolled trial. Am Heart J 2004;147:E3, doi:10.1016/S0002-8703(03)00526-X.Google Scholar