The articles were grouped into four main categories : decision aids and outcome predictors , electrical cardioversion-based protocol s , antiarrhythmic-based protocol s , and general management protocol s. Conclusion This systematic review is the first study to our knowledge to evaluate the optimal management of symptomatic AF/AFLin  the ED with a direct impact on ED disposition .
There are several viable management strategies that can result in safe discharge from the ED in the right patient population , and decision aids can be utilized to guide selection of appropriate patients for discharge
Introduction Management of  atrial fibrillation ( AF ) and atrial flutter ( AFL )  in the emergency department ( ED ) varies greatly , and there are currently no United States guidelines to guide management with regard to patient disposition after ED treatment .
The aim of this systematic review was to evaluate the literature for decision aids to guide disposition of patients with AF/AFLin the ED , and assess potential outcomes associated with different management strategies in the ED .
Biphasic cardioversion of acute atrial fibrillation in the emergency department
Introduction : There is a trend towards accelerated management of acute atrial fibrillation ( AF ) in the emergency department ( ED ) . We report our experience with biphasic cardioversion of acute AF . Methods : This was a prospect i ve , descriptive study at a tertiary hospital ED over a 6 month period . Acute AF was defined as symptoms that had been present for < 48 hours . Patients who received biphasic cardioversion for acute AF in the ED were enrolled . Data collected included : patient demographics , past medical history , details of biphasic cardioversion , outcome , complications , disposition , and length of stay . Results : There were 34 attempts at cardioversion in 33 patients . The mean ( SD ) age was 56 ( 16 ) years and 21 patients ( 64 % ) were men .  Biphasic cardioversion was successful in 31 attempts ( 91 % ) . In 24 attempts ( 71 % ) , 100 J was selected as the initial energy level . This was successful in 21 attempts ( 88 % ) . There were three minor complications related to sedation . The mean ( SD ) length of stay was 5.6 ( 2.8 ) hours in the ED and 15 ( 25 ) hours in the hospital . The three patients who failed to revert were older ( mean age 64 years ) , had underlying cardiovascular disease , and spent longer in hospital ( 50 v 12 hours , p = 0.01 ) . Telephone follow up was conducted with 32 patients ( 97 % ) at 3 months . Recurrence of AF occurred in 7 patients ( 22 % ) . Most patients ( 31 , 97 % ) were satisfied with the biphasic cardioversion . Conclusions : Biphasic cardioversion of acute AF is effective . The majority of patients can be managed as out patients , and there is very high patient satisfaction with this approach . An initial shock energy level of 100 J is usually effective
The articles were grouped into four main categories : decision aids and outcome predictors , electrical cardioversion-based protocol s , antiarrhythmic-based protocol s , and general management protocol s. Conclusion This systematic review is the first study to our knowledge to evaluate the optimal management of symptomatic AF/AFLin  the ED with a direct impact on ED disposition .
There are several viable management strategies that can result in safe discharge from the ED in the right patient population , and decision aids can be utilized to guide selection of appropriate patients for discharge
Introduction Management of  atrial fibrillation ( AF ) and atrial flutter ( AFL )  in the emergency department ( ED ) varies greatly , and there are currently no United States guidelines to guide management with regard to patient disposition after ED treatment .
The aim of this systematic review was to evaluate the literature for decision aids to guide disposition of patients with AF/AFLin the ED , and assess potential outcomes associated with different management strategies in the ED .