Emergency department treatment of clinically stable paroxysmal atrial fibrillation.

Abstract

Introduction. Optimal management of paroxysmal atrial fibrillation (PAF), a common presenting complaint in emergency departments (EDs), remains undetermined. Methods. Six month prospective observational study at three EDs. Patients had clinically stable PAF for less than 48 hours. Conservative (rate control) and aggressive (pharmacologic and/or electrical cardioversion) treatment were analyzed. Results. 169 patients were analyzed, 32 treated conservatively and 137 aggressively. 83.9% of aggressively treated patients converted in the ED, 8.0% were admitted, and 52.3% stayed in sinus rhythm for four weeks. The corresponding proportions for conservative treatment were 34.4%, 37.5%, and 30.0%. There were 15 ED complications (2 rate control, 4 pharmacologic, and 9 electrical), two required admission (one pharmacologic and one electrical). No thromboembolism occurred by four-week follow-up. Conclusions. The results of this study---the first prospective study of ED treatment of PAF---will be used to plan a randomized controlled trial which will compare the two treatments.