What is the efficacy of emergent treatment of atrial flutter?

Updated: Nov 09, 2018
  • Author: Jesse Borke, MD, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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In a study by Stiell et al, the Ottawa Aggressive Protocol, which includes chemical cardioversion; electrical cardioversion, if needed; and discharge home from the emergency department (ED), was found to possibly be safe, rapid, and effective, and to be potentially capable of reducing hospital admission. [6]  Further study of this protocol is needed.

A Canadian study suggested that patients treated in the ED for uncomplicated atrial fibrillation or atrial flutter who are at particular risk for associated stroke may not, in many cases, receive anticoagulant therapy. [7] The investigators found that of the 732 patients in the study who were discharged from the ED without cardiologic consultation (including 75 with atrial flutter), a significant number did not receive appropriate anticoagulation.

Similarly, a 2017 multicenter report by Stiell et al that prospectively evaluated management and 30-day outcomes in 1091 ED patients with recent-onset atrial fibrillation (84.7%) or atrial flutter (15.3%) found that oral anticoagulants were underprescribed and that patients discharged from the ED in sinus rhythm had a smaller likelihood of experiencing an adverse event. [8]  More than 10% of all patients had adverse events within 30 days, including 1 case of stroke, but no deaths were reported. Potential risk factors for adverse events included longer duration from arrhythmia onset, radiographic evidence of pulmonary congestion, previous history of stroke/transient ischemic attack, and ED discharge without being in sinus rhythm. [8]

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