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. 2012 Apr;20(4):148-54.
doi: 10.1007/s12471-011-0208-z.

Planning and monitoring of patients for electrical cardioversion for atrial fibrillation

J H H Deuling  1 , R P Vermeulen, M D Smit, J M A A van der Maaten, H M Boersema, A F M van den Heuvel, I C Van Gelder
Affiliations

Planning and monitoring of patients for electrical cardioversion for atrial fibrillation

J H H Deuling et al. Neth Heart J. 2012 Apr.

Abstract

Objectives: This study evaluated the waiting list for elective electrical cardioversion (ECV) for persistent atrial fibrillation (AF), focusing on when and why procedures were postponed. We compared the effects of management of the waiting list conducted by physicians versus management by nurse practitioners (NPs) and we evaluated the safety of our anticoagulating policy by means of bleeding or thromboembolic complications during and after ECV.

Background: Not all patients selected for ECV receive their treatment at the first planned instance due to a variety of reasons. These reasons are still undocumented.

Methods: We evaluated 250 consecutive patients with persistent AF admitted to our clinic for elective ECV.

Results: Within 5 to 6 weeks, 186 of 242 patients (77%) received ECV. The main reason for postponing an ECV was an inadequate international normalised ratio (INR); other reasons included spontaneous sinus rhythm and switch to rate control. A total of 23 of the 147 patients (16%) managed by the research physician were postponed due to an inadequate INR at admission versus 4 out of 98 patients (4%) managed by NPs (p = 0.005)

Conclusion: An inadequate INR is the main reason for postponing an ECV. Management of ECV by NPs is safe and leads to less postponing on admission.

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Figures

Fig. 1
Fig. 1
Protocol for electrical cardioversion at the University Medical Centre Groningen
Fig. 2
Fig. 2
Patient flow chart over planned and rescheduled ECV procedures
Fig. 3
Fig. 3
Reasons for postponing ECV
Fig. 4
Fig. 4
Waiting days before ECV, managed by physician and NP
See this image and copyright information in PMC

References

    1. Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347(23):1834–1840. doi: 10.1056/NEJMoa021375. - DOI - PubMed
    1. Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825–1833. doi: 10.1056/NEJMoa021328. - DOI - PubMed
    1. European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery. Camm AJ, Kirchhof P, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Eur Heart J. 2010;31(19):2369–2429. doi: 10.1093/eurheartj/ehq278. - DOI - PubMed
    1. Hirsh J, Fuster V, Ansell J, et al. American Heart Association/American College of Cardiology Foundation. American Heart Association/American College of Cardiology. Foundation guide to warfarin therapy. J Am Coll Cardiol. 2003;41(9):1633–1652. doi: 10.1016/S0735-1097(03)00416-9. - DOI - PubMed
    1. European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery. Camm AJ, Kirchhof P, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Europace. 2010;12(10):1360–1420. doi: 10.1093/europace/euq350. - DOI - PubMed

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