ER Patients With Atrial Flutter May Fare Better With Defibrillation

February 4, 2011 – In the largest group of emergency department patients with atrial flutter studied to date, researchers found these patients may be substantially different from those described in the cardiology literature. The results of the study were published in the Annals of Emergency Medicine. Atrial flutter is an abnormal heart rhythm that may be a symptom of a medical problem. "Management of atrial flutter patients in the emergency department is controversial," said lead study author Frank Scheuermeyer, M.D., MHSc, of the department of emergency medicine at St. Paul's Hospital and the University of British Columbia in Vancouver, Canada. "There is no standard formula for treatment of these patients by emergency physicians. For that reason, although atrial flutter is very common, management of it in the emergency department has created a therapeutic dilemma for emergency physicians." Of the patients who were treated with electrical cardioversion (or defibrillation), 91 percent achieved a normal heart rhythm and 93 percent were discharged home. Of the patients who were treated chemically, 27 percent achieved a normal heart rhythm, and 60 percent were discharged home. No patients in either group had died or had a stroke in the next year. Emergency patients undergoing defibrillation required substantial amounts of energy, with 17 percent receiving at least 150 joules to achieve a normal heart rhythm. This contrasts with cardiology literature suggesting that 70 percent of patients convert to normal rhythm with much lower energy levels (20 to 30 joules). None went into atrial fibrillation despite cardiology research that suggests that 10 to 15 percent of patients may be shocked into fibrillation. "Our study suggests that electrical cardioversion was preferred for eligible patients and was more successful than chemical intervention," Scheuermeyer said. "This suggests that cardioversion is faster and more effective, making it a dominant first-line strategy for eligible patients." For more information: www.acep.org