NEW YORK (Reuters Health) – Atrial flutter seen in patients in the emergency department (ED) resolves more often with electrical cardioversion than with antiarrhythmic drug treatment, and long-term outcomes are good, a Canadian study indicates.

“The ED management of patients with atrial flutter is controversial,” the researchers note in the Annals of Emergency Medicine online January 20. “ED electrocardioversion of atrial flutter has been little described in the literature.”

Dr. Frank Scheuermeyer, with St. Paul’s Hospital and the University of British Columbia, Vancouver, and colleagues conducted a retrospective cohort study of 122 consecutive patients presenting with atrial fibrillation.

Patients were classified based on the management strategy used during their emergency department (ED) visit: electrical countershock; antiarrhythmic medication; unaided conversion to sinus rhythm; rate-control medication only; or no attempted control and no conversion to normal sinus rhythm.

The primary outcome was a combination of stroke or death at 1 year. There were no strokes but 2 patients died in the rate-control-only group and 1 in the no-ED-management group, according to the report.

As for measures of ED outcomes, 91.3% of patients undergoing electrocardioversion achieved normal sinus rhythm compared with 26.7% of those given antiarrhythmic medication. Furthermore, 93.5% of the electrocardioversion group versus 60.0% of the medication group were discharged directly home.

Discharge rates were 93.3% among patients with spontaneous cardioversion, 58.3% in those given rate-control medication only, and 95.4% among the group not treated in the ED.

The 46 patients who underwent electrocardioversion were relatively young and low risk, and “the majority had received successful cardioversion before,” Dr. Scheuermeyer and colleagues point out. “High success and low complication rates in this group suggest that electrical cardioversion may be an appropriate ED strategy for low-risk patients with atrial flutter.”

Conversely, “Oral and intravenous antiarrhythmic medications seldom achieved conversion to normal sinus rhythm.”

The authors conclude, “Patients eligible for rhythm control had a higher success and lower admission rate with electrocardioversion than patients treated with antiarrhythmic medications. Overall, the majority of patients were discharged home.”

Reference:

Emergency Department Management and 1-Year Outcomes of Patients With Atrial Flutter

Ann Emerg Med 2011.