A Prospective, Randomized Trial of an Emergency Department Observation Unit for Acute Onset Atrial Fibrillation

• Published in: Academic emergency medicine 2003-05, Vol.10 (5), p.543-544
• Main Author: Decker, W. W
• Format: Article
• Language: English
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1197/aemj.10.5.543-b

OBJECTIVES: We compared an Emergency Department Observation Unit (EDOU) protocol for the management of acute onset atrial fibrillation (AF) to routine hospital admission. METHODS: This IRB-approved prospective, randomized study was performed in a tertiary referral center ED between September 1999 and December 2002. Adult patients presenting to the ED with AF of < 48 hours duration and without hemodynamic instability or other conditions requiring hospitalization were eligible to participate. Participants were randomized to either care in the EDOU or routine inpatient care. The EDOU protocol included heart rate control, 6 hours of cardiac monitoring, and reassessment. Those still in AF after a 6-hour observation period were electrically cardioverted and observed for two more hours. Those in sinus rhythm (SR) after the observation period were discharged home with cardiology follow-up within 3 days while those still in AF were admitted. All patients were followed for 6 months for adverse events, recurrent AF, and return visits. RESULTS: 156 patients were enrolled and data analysis has been performed on the initial 75 patients. 34 of the 75 patients were randomized to the EDOU and 41 to routine care. 88% (28) of EDOU patients converted to NSR, vs. 95% (39) in the routine care group (P = 0.39). The median length of stay was 10 vs. 24 hours (P < 0.001) for EDOU and routine care patients respectively. Seven EDOU patients required inpatient admission. 26% (9) of the EDOU group had recurrence of atrial fibrillation during follow-up vs. 34% (14) of the routine inpatient care group (P = 0.62). There were no significant differences between the groups in the frequency of hospitalization, number of tests/procedures, or adverse events during followup. CONCLUSION: An 8-hour EDOU protocol that includes electrical cardioversion appears to be a viable alternative to routine hospital admission for patients with acute onset of AF, and results in a shorter initial length of stay.