Atrial fibrillation: a retrospective chart review of complications, morbidity and mortality at 30 days
Authors: Piersma F R , Breel J S , Krul S P J , Eberl S , Wensing A G C L , Deutekom F E , Groot J R 
Published: October 2022

Abstract

Introduction
Atrial fibrillation (AF) increasingly burdens medical health systems. Electrical cardioversion (ECV) forms an important rhythm control treatment for AF. Complications associated with this procedure include stroke and other arrhythmias.
Currently, institutional sedation protocols state that patients have to be admitted if 24-hour supervision by family or friends cannot be provided. This implies increased costs, both financially and by occupying a hospital bed. We anticipate that this strategy of admitting patients will become a problem in the future due to the rapid increase of AF patient due to aging of the population.

Purpose
Our aim is to analyse the incidence, type and timing of complications, to determine whether additional supervision is justified.

Methods
This was a retrospective single-centre study, in a large tertiary care hospital in the Netherlands. The study was approved by the Ethical Commission, registered with the Netherlands Trial Register (NL9433). Patients were contacted, those who did not object to the reuse of care data were included. Data was extracted from the electronic patient file, entered into a research database, and analysed. This study includes all eligible elective ECV's performed under general anaesthesia, in 2019. We analysed at the number of documented complications within 2 hours (T1), between 2 and 24 hours (T2) and within 30 days of the ECV (T3).

Results
In total, 370 patients were approached, 7 patients refused consent and 363 unique patients with 564 ECV procedures were included. The majority were male (66%), mean age 65±12 years, BMI 28±6 kg/m2, 49% smoker (current or past), 19% had previously undergone a form of AF ablation, 115 (32%) patients underwent ≥2 ECV's (range 2–11), and 6 patients were admitted due to a social indication.
In T1, 22 complications in 16 ECV's were documented, mostly unrelated to anaesthesia: asystole (3, &gt;5 seconds asystole during/after procedure), hypotension (8), extreme bradycardia (8), chest-wall burn pain (1), and arrhythmias other than AF that developed after ECV (2). Nine complications in 7 ECVs (bradycardia, asystole and arrhythmias) were considered severe enough for admission, 5 patients were diagnosed with SSS/brady-tachy syndrome and were implanted with a pacemaker later.
In T2, 11 complications were documented: bradycardia (1), skin pain (3), muscle pain (2), fatigue (4), fainting and palpitations (1). The latter patient developed bradycardia and recurrent AF, and was readmitted.In T3, 15 complications were documented of which 5 were severe (CVA, angina, heart failure, arrhythmias).

Conclusion
Based on this retrospective analysis of all eligible ECV's in a large tertiary hospital, performed in 2019, complications in T2 (1,8%) needed no further treatment. We therefore conclude that it seems safe to discharge patients to their homes without extra supervision after sedation ECV

Funding Acknowledgement
Type of funding sources: None.