• Rachel Dankner, Amir Shahar, Ilya Novikov, Uri Agmon, Arnona Ziv, and Hanoch Hod.
• Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel. racheld@gertner.health.gov.il
• Cardiology. 2009 Jan 1;112(4):270-8.

ObjectiveTo compare the success rates and short-term complications of three treatment approaches, pharmacological and direct-current cardioversion (DCC), or 'wait-and-watch' among stable atrial fibrillation (AF) patients in the emergency department (ED).MethodsAll AF-related ED admissions during a 1-year period were retrospectively reviewed, and those meeting criteria of eligibility for immediate cardioversion, based on clinical stability, AF duration and adequacy of anticoagulation, were included. The propensity score approach generalized for the three groups was used to adjust for the observational non-randomized study nature.ResultsAmong 374 eligible patients, the rate of successful cardioversion was higher in DCC than in pharmacological or wait-and-watch groups (78.2, 59.2 and 37.9% respectively, p < 0.001), with corresponding percentages of patients discharged from ED (52.9, 47.9 and 32.1%, p < 0.01) and respective odds ratios of 6.00, 2.47 and 1, adjusting for seniority of the treating physician, age, gender and patient comorbidities. DCC was 2.43 times more effective than pharmacological treatment in achieving sinus rhythm (95% confidence interval = 1.36-4.33, p = 0.003). Rehospitalization within 14 days due to probable AF-treatment-related complications of home-discharged patients was 3.4%.ConclusionsDCC was found to be the most effective treatment, with few short-term complications following conversion of stable AF patients to sinus rhythm in the ED.Copyright 2008 S. Karger AG, Basel.

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