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Hypotension and respiratory events related to electrical cardioversion for atrial fibrillation or atrial flutter in the emergency department

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Abstract

Introduction

Electrical cardioversion for atrial fibrillation/atrial flutter (AF/AFL) is common in the ED. Our previous work showed that hypotension and respiratory events were important adverse events that occurred in patients undergoing electrical cardioversion for AF/AFL. The purpose of this study was to examine if (1) beta-blockers or calcium channel blocker use prior to ECV were associated with hypotension and (2) medications used for procedural sedation were associated with respiratory events.

Methods

This was a secondary analysis of pooled study data from four previous multicentred studies on AF/AFL. We conducted a multivariable logistic regression to examine predictors of hypotension and respiratory adverse events.

Results

There were 1736 patients who received ECV. A hypotensive event occurred in 62 (3.6%) patients. There was no significant difference in the odds of a hypotensive event in patients who received a beta-blocker or calcium channel blocker in the ED compared to no rate control. Procedural sedation with fentanyl (OR 2.01 95% CI 1.15–3.51) and home beta-blocker use (OR 1.92, 95% CI 1.14–3.21) were significantly associated with hypotensive events. A respiratory event occurred in 179 (10.3%) patients. Older age (OR 2.02, 95% CI 1.30- 3.15) and receiving midazolam for procedural sedation were found to be significantly associated with respiratory events (OR 1.99, 95% CI 1.02–3.88).

Conclusion

Beta-blocker or calcium channel blocker use prior to ECV for AF/AFL was not associated with hypotension. However, sedation with fentanyl and home beta-blocker use was associated with hypotension. The use of midazolam for procedural sedation was significantly associated with respiratory events.

Résumé

Introduction

La cardioversion électrique pour la fibrillation auriculaire / flutter auriculaire (AF / AFL) est fréquente aux urgences. Nos travaux précédents ont montré que l’hypotension et les événements respiratoires étaient des événements indésirables importants qui se sont produits chez les patients subissant une cardioversion électrique pour AF / AFL. Le but de cette étude était d’examiner si 1) les bêtabloquants ou les inhibiteurs calciques utilisés avant l’ECV étaient associés à l’hypotension et 2) les médicaments utilisés pour la sédation procédurale sont associés à des événements respiratoires.

Méthodes

Il s’agissait d’une analyse secondaire des données d’études regroupées de quatre études multicentriques précédentes sur l’AF/AFL. Nous avons effectué une régression logistique multivariée pour examiner les prédicteurs de l’hypotension et des événements indésirables respiratoires.

Résultats

Il y avait 1736 patients qui ont reçu ECV. Un événement hypotenseur s’est produit dans 62 (3,6%) patients. Il n’y avait pas de différence significative dans la probabilité d’un événement hypotenseur chez les patients qui ont reçu un bêtabloquant ou un inhibiteur calcique à l’urgence par rapport à aucun contrôle de taux. La sédation procédurale avec du fentanyl (RC 2,01 à 95 %, IC 1,15 à 3,51) et l’utilisation de bêtabloquants à domicile (RC 1,92, IC à 95 %, 1,14 à 3,21) étaient significativement associées à des événements hypotensifs. Un événement respiratoire est survenu chez 179 (10,3 %) patients. Un âge plus avancé (RC 2,02, IC à 95 % : 1,30 à 3,15) et la réception de midazolam pour sédation procédurale étaient significativement associés à des événements respiratoires (RC 1,99, IC à 95 % 1,02-3,88).

Conclusions

L’utilisation d’un bêtabloquant ou d’un inhibiteur calcique avant l’ECV pour l’AF/AFL n’était pas associée à l’hypotension. Cependant, la sédation avec du fentanyl et l’utilisation de bêtabloquants à domicile étaient associées à l’hypotension. L’utilisation du midazolam pour la sédation procédurale était significativement associée aux événements respiratoires.

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Data availability

The dataset from this study is held securely in coded form at the University of Ottawa. The dataset is not publically available. However, the analytic plan and code may be made available from the authors upon request.

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Acknowledgements

Thank you to the RAFF investigators and sites for data collection for the original studies.

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Authors and Affiliations

  1. Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada

    Sharon Liu, Bjug Borgundvaag & Keerat Grewal

  2. Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Sharon Liu & Bjug Borgundvaag

  3. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada

    Ian Stiell & Debra Eagles

  4. Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada

    Ian Stiell & Debra Eagles

  5. Division of Emergency Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Keerat Grewal

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  1. Sharon Liu
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  2. Ian Stiell
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Correspondence to Keerat Grewal.

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Liu, S., Stiell, I., Eagles, D. et al. Hypotension and respiratory events related to electrical cardioversion for atrial fibrillation or atrial flutter in the emergency department. Can J Emerg Med 26, 103–110 (2024). https://doi.org/10.1007/s43678-023-00621-z

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  • DOI: https://doi.org/10.1007/s43678-023-00621-z

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