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Cardioversion of uncomplicated paroxysmal atrial fibrillation: a survey of practice by Canadian emergency physicians

Published online by Cambridge University Press:  21 May 2015

Bjug Borgundvaag  and
Howard Ovens
Bjug Borgundvaag*
Affiliation:
Division of Emergency Services, Schwartz/Reisman Emergency Centre, Mount Sinai Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Ont.
Howard Ovens
Affiliation:
Division of Emergency Services, Schwartz/Reisman Emergency Centre, Mount Sinai Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Ont.
*
Mount Sinai Hospital, 600 University Ave., Rm. 206, Emergency Physicians Office, Toronto ON M5G 1X5; [email protected]

Abstract

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Objective:

Paroxysmal atrial fibrillation (PAF) is the rhythm disturbance most commonly encountered by emergency physicians, yet the role played by emergency physicians in the management of this condition has not been well described. The purpose of this study was to describe the management of uncomplicated PAF by Canadian emergency physicians.

Methods:

All members of the Canadian Association of Emergency Physicians with a Canadian address (n = 1255) were mailed a 15-point questionnaire regarding training/certification, hospital demographics and practice patterns regarding the management of uncomplicated PAF. Chisquared analysis and Fisher’s Exact test were performed to identify significant differences in reported practice patterns in relation to demographic variables. Significant associations were tested for interaction using the Mantel–Haenszel test.

Results:

We received 663 responses, representing a 52.8% response rate. Six hundred and twenty-two (95%), 514 (78%) and 242 (38%) respondents reported routine performance of rate control, chemical cardioversion and electrical cardioversion respectively. Physicians working in high-volume emergency departments (>50 000 visits/yr) were significantly more likely to self-manage rate control and chemical/electrical cardioversion than those working in lower volume emergency departments. Residency training was associated with higher performance of electrical (44% v. 31%, p < 0.01) but not chemical cardioversion or rate control, although, amongst residency trained physicians, those with FRCP-level training were significantly more likely to perform both chemical (86% v. 76%, p < 0.05) and electrical (57% v. 37%, p < 0.01) cardioversion.

Conclusion:

Canadian emergency physicians surveyed in this study actively manage uncomplicated PAF. We found significant variations in practice, especially related to the use of electrical cardioversion. This may reflect different practice environments, levels of training, and lack of evidence to guide best practice. Further research is required to determine the optimal care of PAF in the emergency department setting.

Keywords

paroxysmal atrial fibrillationemergency managementcardioversion
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 3 , May 2004 , pp. 155 - 160
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

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