EBQ:Ottawa Aggressive ED Cardioversion Protocol - Revision history

JoshuaSorenson: /* Major Points */

2021-01-03T22:39:53Z

Major Points

← Older revision		Revision as of 22:39, 3 January 2021
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	\| Procainamide IV (1 g IV over 60 min; hold if blood pressure < 100 mm Hg)		\| Procainamide IV (1 g IV over 60 min; hold if blood pressure < 100 mm Hg)
	\|-		\|-
	\|style="background:#f0f0f0;"\|'''4.Electrical cardioversion'''		\|style="background:#f0f0f0;"\|'''4. Electrical cardioversion'''
	\|-		\|-
	\| Consider keeping patient NPO × 6 h		\| Consider keeping patient NPO × 6 h
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	\| If CHADS2 score ≥ 1, consider warfarin and arrange early follow-up		\| If CHADS2 score ≥ 1, consider warfarin and arrange early follow-up
	\|}		\|}

	==Study Design==		==Study Design==
	*Single study retrospective cohort of ED patients presenting with recent onset atrial fibrillation (<48hrs)		*Single study retrospective cohort of ED patients presenting with recent onset atrial fibrillation (<48hrs)

2016-03-22T13:54:02Z

Text replacement - "Category:Cards" to "Category:Cardiology"

2015-01-31T15:41:09Z

← Older revision		Revision as of 15:41, 31 January 2015
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	\| fulltexturl= http://www.cjem-online.ca/v12/n3/p181		\| fulltexturl= http://www.cjem-online.ca/v12/n3/p181
	\| pdfurl=http://www.cjem-online.ca/sites/default/files/pg181.pdf		\| pdfurl=http://www.cjem-online.ca/sites/default/files/pg181.pdf
	\| status = ~~Under Review~~		\| status = Complete
	}}		}}
	==Clinical Question==		==Clinical Question==

2015-01-31T15:40:47Z

Criticisms & Further Discussion

← Older revision		Revision as of 15:40, 31 January 2015
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	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
	*In general, practice guidelines recommended anticoagulation for the conversion of atrialfibillatin or flutter if duration of dysrhythmia is > 48 hours. More recent literature suggests that the 12-48 hour window in this study still only represented a 1.1% risk for 30-day thromboembolism, compared to the ~2% risk after 48 hours.		*In general, practice guidelines recommended anticoagulation for the conversion of atrialfibillatin or flutter if duration of dysrhythmia is > 48 hours. More recent literature suggests that the 12-48 hour window in this study still only represented a 1.1% risk for 30-day thromboembolism, compared to the ~2% risk after 48 hours.

			*Although this study demonstrates the safety and efficacy of a cardioversion first strategy in the ED in new onset (<48hr) [[Atrial Fibrillation]] it was performed in a system with very good outpatient followup. Results of this study should be individualized the healthcare system of practice.
	===Anticoagulation prior to cardioversion===		===Anticoagulation prior to cardioversion===
	{{Anticoagulation prior to cardioversion}}		{{Anticoagulation prior to cardioversion}}

2015-01-26T20:15:14Z

Outcomes

← Older revision		Revision as of 20:15, 26 January 2015
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	**Death: 0%		**Death: 0%
	**Relapse within 7 days: 8.7%		**Relapse within 7 days: 8.7%

	~~===Subgroup analysis===~~



	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==

2015-01-26T20:14:49Z

Secondary Outcomes

← Older revision		Revision as of 20:14, 26 January 2015
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	===Secondary Outcomes===		===Secondary Outcomes===
	*Death, stroke or relapse to atrial fibrillation within 7 days		*Death, stroke or relapse to atrial fibrillation within 7 days
			**Stroke: 0%
			**Death: 0%
			**Relapse within 7 days: 8.7%

	===Subgroup analysis===		===Subgroup analysis===

2015-01-26T20:13:50Z

Primary Outcome

← Older revision		Revision as of 20:13, 26 January 2015
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	===Primary Outcome===		===Primary Outcome===
	*Proportion of patients converted to sinus rhythm before discharge from ED		*Proportion of patients converted to sinus rhythm before discharge from ED
			**58% of all cases responded to procainamide
			**92% responded to electrical cardioversion
	*Length of stay in ED		*Length of stay in ED
			**Mean length of stay <5 hours
	*Final disposition and adverse events (hypotension or arrhythmia)		*Final disposition and adverse events (hypotension or arrhythmia)
			**97% discharged home
			**90 discharged with normal sinus rhythm

	===Secondary Outcomes===		===Secondary Outcomes===
	*Death, stroke or relapse to atrial fibrillation within 7 days		*Death, stroke or relapse to atrial fibrillation within 7 days

2015-01-26T20:06:57Z

Interventions

← Older revision		Revision as of 20:06, 26 January 2015
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	*Atrial fibrillation >48hrs		*Atrial fibrillation >48hrs
	*Presence of other diagnosis requiring admission		*Presence of other diagnosis requiring admission
	==Interventions==		==Interventions==
			*Patients were cardioverted with procainamide or electrically

	==Outcomes==		==Outcomes==
	===Primary Outcome===		===Primary Outcome===

2015-01-26T20:06:06Z

Patient Demographics

@@ Line 104: / Line 104: @@
 ==Population==
 ===Patient Demographics===
 ===Inclusion Criteria===
 *Recent onset (<48 hrs) of atrial flutter

2015-01-26T19:59:58Z

@@ Line 25: / Line 25: @@
 *The relapse rate for atrial fibrillation is 3% -17% and close followup and ability to return to the ED if there is return of symptoms is essential.<ref name="von Besser"></ref>
 ==Study Design==
-*Single study consecutive retrospective cohort of ED patients presenting with recent onset atrial fibrillation (<48hrs)
+*Single study retrospective cohort of ED patients presenting with recent onset atrial fibrillation (<48hrs)
 *660 patients
 *June 2000-June 2005
 ==Population==
 ===Patient Demographics===
 ===Inclusion Criteria===
+*Recent onset (<48 hrs) of atrial flutter
 ===Exclusion Criteria===
+*Atrial fibrillation >48hrs
 ==Interventions==
 ==Outcomes==
 ===Primary Outcome===
 ===Secondary Outcomes===