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Outcome of pharmacological treatment of patients with atrial fibrillation in the emergency room

Two pharmacological approaches are established in the treatment of atrial fibrillation (AF): 'rhythm control' – usage of antiarrhythmic agents, in order to restore and maintain normal sinus rhythm (NSR); and 'rate control' – usage of agents that prolong cardiac atrioventricular conduction, in order to alleviate clinical symptoms. A retrospective study was conducted, aiming to determine outcome of pharmacological treatment of patients with AF in the emergency room (ER). Discharge Letters of all patients admitted to the ER and subsequently diagnosed with AF over a 1-year period were reviewed (May 2001–May 2002). Data on symptoms duration, drugs administered and outcome of treatment were analysed.

In a 1-year period, AF was registered in 242 patients, which represented 4% of total medical emergency admissions (n = 6142). In patients with AF, 64% (n = 152) had paroxysmal AF, 12% (n = 29) had persistent AF, and 24% (n = 58) had permanent AF. In a group of patients with paroxysmal AF, pharmacological conversion into NSR was attempted in 74% of patients (n = 113). 'Rhythm control' was achieved in 50% (n = 56) of patients, 'rate control' in 12% (n = 14) and 38% (n = 43) of patients required prolonged hospital treatment. The anti-arrhythmic drug of choice was propafenon, with conversion attempted in 62% of patients (n = 71) and control achieved in 61% (n = 43), and amiodarone, with conversion attempted in 7% of patients (n = 8), and rhythm control achieved in 50% patients (n = 4).

In a group of patients with permanent AF (n = 58), pharmacological treatment was attempted in 69% of patients (n = 40). 'Rate control' was achieved in 50% (n = 20) patients, whereas the others required prolonged hospital treatment. The pharmacological drug of choice was a combination of verapamil and digoxine, with 81% success rate.

AF is the most common cardiac arrthymia presented in the emergency room. The 'rhythm control' approach still represents the main target in the treatment of patients with AF presented in the emergency room, whereas 'rate control' is attempted in patients with persistent and permanent AF. In the study, the drug of choice for pharmacological conversion of AF into NSR is propafenon, and for 'rate control' the best results are obtained by administering the combination of verapamil and digoxine.

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Ivekovic, H., Gasparovic, V. Outcome of pharmacological treatment of patients with atrial fibrillation in the emergency room. Crit Care 7, P058 (2003). https://doi.org/10.1186/cc1947

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  • DOI: https://doi.org/10.1186/cc1947

Keywords

  • Atrial Fibrillation
  • Verapamil
  • Pharmacological Treatment
  • Emergency Room
  • Amiodarone