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Cardioversion of acute atrial fibrillation in the short observation unit: comparison of a protocol focused on electrical cardioversion with simple antiarrhythmic treatment
  1. Lorenzo Cristoni1,
  2. Andrea Tampieri1,
  3. Fabrizio Mucci1,
  4. Primiano Iannone1,
  5. Alessandro Venturi2,
  6. Mario Cavazza2,
  7. Tiziano Lenzi1
  1. 1Emergency Department, Ospedale Civile S M della Scaletta, Imola, Italy
  2. 2Emergency Department, Ospedale S Orsola-Malpighi, Bologna, Italy
  1. Correspondence to Dr Lorenzo Cristoni, Ospedale Civile Santa Maria della Scaletta, via Montericco 4, 40026 Imola, Italy; lorenzo.cristoni{at}


Background Direct current cardioversion (DCC) has been shown to be effective for the management of atrial fibrillation (AF) in the emergency department (ED). Pharmacological cardioversion was compared with a strategy including DCC on patients with uncomplicated, recent-onset (<48 h) AF managed in a short observation unit (SOU).

Methods A prospective observational study was undertaken over a period of 13 months in two institutions. A DCC-centred protocol was applied to 171 AF cases in a hospital (DCC-cohort) and pharmacological cardioversion to 151 AF cases in another hospital (P-cohort). Patients remaining in AF after 24 h were admitted. The outcomes were rate of discharge in sinus rhythm, length of stay in the ED-SOU, rate of hospitalisation and complications of treatment. Data collected were analysed according to Student t test and χ2 statistics.

Results Discharge in sinus rhythm was achieved in 159/171 cases in the DCC-cohort and 77/151 cases in the P-cohort (93% vs 51%; number needed to treat (NNT) 2.4; 95% CI 2.0 to 3.1, p<0.001), whereas mean length of stay was 7+7 h in the DCC-cohort and 9+6 h in the P-cohort (p=0.43). Eleven cases from the DCC-cohort and 67 from the P-cohort were admitted (admission rate 6% vs 44%; NNT 2.6; 95% CI 2.2 to 3.5, p<0.001). Three short-term complications occurred in the DCC-cohort and five in the P-cohort (2% vs 3%, p=0.59). Two strokes were registered in the DCC-cohort during 6-month follow-up (p undefined).

Conclusions Electrical cardioversion of recent-onset AF in the SOU is safe, effective and reduces hospitalisations. Further studies are needed to identify the most cost-effective strategy for the management of AF patients in emergency settings.

  • Atrial fibrillation
  • cardiac electroversion
  • antiarrhythmia agents
  • short observation unit
  • stroke
  • cardiac care
  • arrythmia
  • treatment
  • clinical assessment
  • effectiveness
  • management
  • emergency department management
  • neurology
  • stroke

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.