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Cardioversion and Acute Atrial Fibrillation Management

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Short Stay Management of Atrial Fibrillation

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

There are more than six million people with atrial fibrillation (AF) in the United States, and approximately 1.6 million new cases occur annually. Many such patients present to the emergency department (ED) and require management of symptoms or an unfavorable hemodynamic profile. Whereas heart rate control has historically been the focus of ED management, attempts to cardiovert selected patients to sinus rhythm have been shown to be a safe and cost-effective strategy that can negate the need for hospital admission for many patients. The decision to pursue an early rhythm control strategy depends on a variety of factors, including patient stability, age, precipitants, coinciding heart failure, duration of the AF episode, and more. However, there is tremendous variation across providers, hospital systems, and even regions with regard to how new-onset AF is managed in acute setting. The goal of this review is to outline indications and techniques for cardioversion of new-onset AF – both pharmacologic cardioversion (PC) and electrical cardioversion (EC) – in the first 24–48 h after a patient arrives to the hospital/ED. One of the central tenets of cardioversion should be considered when reading this review – namely, that symptomatic patients benefit from cardioversion whereas asymptomatic patients may not.

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Author information

Authors and Affiliations

  1. Department of Emergency Medicine, UMass-Memorial Medical Center, Worcester, MA, USA

    Chad E. Darling MD, MSc

  2. Department of Emergency Medicine, University of Massachusetts Medical Center, Worcester, MA, USA

    Christian G. Klaucke MD

  3. Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA

    David D. McManus MD, ScM

Authors
  1. Chad E. Darling MD, MSc
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  2. Christian G. Klaucke MD
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  3. David D. McManus MD, ScM
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Corresponding author

Correspondence to Chad E. Darling MD, MSc .

Editor information

Editors and Affiliations

  1. Baylor College of Medicine, Department of Emergency Medicine Baylor College of Medicine, HOUSTON, Texas, USA

    W. Frank Peacock

  2. Department of Emergency Medicine, Beaumont Health System, William Beaumont Hospital, William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan, USA

    Carol L. Clark

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Darling, C.E., Klaucke, C.G., McManus, D.D. (2016). Cardioversion and Acute Atrial Fibrillation Management. In: Peacock, W., Clark, C. (eds) Short Stay Management of Atrial Fibrillation. Contemporary Cardiology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-31386-3_10

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  • DOI: https://doi.org/10.1007/978-3-319-31386-3_10

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  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-31384-9

  • Online ISBN: 978-3-319-31386-3

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