Can Cardioversion of New-Onset Atrial Fibrillation Be Safely Delayed in the ED?

For achieving sinus rhythm within 4 weeks and avoiding cardiovascular complications, immediate cardioversion in the emergency department was no better than cardioversion at 48 hours.

Atrial fibrillation (AF) is a common presentation in the emergency department (ED), but it's not always clear whether a patient with new-onset AF should undergo cardioversion immediately or be allowed some time for spontaneous conversion. Patients with marked AF symptoms certainly have no luxury to wait, but what about patients whose symptoms are less dramatic?

At two EDs in the Netherlands (NCT02248753), investigators randomized 437 adults with hemodynamically stable, symptomatic AF of recent onset (<36 hours) to undergo cardioversion either early (immediately) or after a delay (48 hours after symptom onset). The primary analysis included 427 patients (mean age, 65). About 40% were taking an anticoagulant at enrollment; another 29% started …

Reviewing Author

Mark S. Link, MD

Disclosures

Editorial BoardsCirculation; UpToDate

Mark S. Link, MD

Disclosures

Editorial BoardsCirculation; UpToDate

Can Cardioversion of New-Onset Atrial Fibrillation Be Safely Delayed in the ED?

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Reviewing Author