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Planning and monitoring of patients for electrical cardioversion for atrial fibrillation.

Deuling JH, Vermeulen RP, Smit MD, van der Maaten JM, Boersema HM, van den Heuvel AF, Van Gelder IC - Neth Heart J (2012)

Bottom Line: Within 5 to 6 weeks, 186 of 242 patients (77%) received ECV.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) 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.

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.

No MeSH data available.


Related in: MedlinePlus

Patient flow chart over planned and rescheduled ECV procedures
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Fig2: Patient flow chart over planned and rescheduled ECV procedures

Mentions: Of the 250 patients referred for electrical cardioversion, 8 patients (3%) were primarily not accepted for an ECV because of an inappropriate treatment of underlying diseases. Table 1 shows baseline characteristics of the 242 patients who underwent ECV. Most were male (72%) with a mean age of 63 years. Duration of the current AF episode was a median of 3 months. Figure 2 shows the flowchart of patients who were scheduled for ECV. Within 5 to 6 weeks, 186 of 242 patients (77%) received ECV. After 5 rescheduled ECVs, all patients on the waiting list had been treated with ECV (n = 218, 90%). Patients were taken off the waiting list for reasons of spontaneous conversion to sinus rhythm (n = 16, 7%), switch to rate control (n = 5, 2%), hospital admission for symptomatic AF necessitating an unplanned ECV (n = 1, 1%), sustained ventricular tachycardia (n = 1, 1%), and crossover to pulmonary vein ablation (n = 1, 1%).Table 1


Planning and monitoring of patients for electrical cardioversion for atrial fibrillation.

Deuling JH, Vermeulen RP, Smit MD, van der Maaten JM, Boersema HM, van den Heuvel AF, Van Gelder IC - Neth Heart J (2012)

Patient flow chart over planned and rescheduled ECV procedures
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3303022&req=5

Fig2: Patient flow chart over planned and rescheduled ECV procedures
Mentions: Of the 250 patients referred for electrical cardioversion, 8 patients (3%) were primarily not accepted for an ECV because of an inappropriate treatment of underlying diseases. Table 1 shows baseline characteristics of the 242 patients who underwent ECV. Most were male (72%) with a mean age of 63 years. Duration of the current AF episode was a median of 3 months. Figure 2 shows the flowchart of patients who were scheduled for ECV. Within 5 to 6 weeks, 186 of 242 patients (77%) received ECV. After 5 rescheduled ECVs, all patients on the waiting list had been treated with ECV (n = 218, 90%). Patients were taken off the waiting list for reasons of spontaneous conversion to sinus rhythm (n = 16, 7%), switch to rate control (n = 5, 2%), hospital admission for symptomatic AF necessitating an unplanned ECV (n = 1, 1%), sustained ventricular tachycardia (n = 1, 1%), and crossover to pulmonary vein ablation (n = 1, 1%).Table 1

Bottom Line: Within 5 to 6 weeks, 186 of 242 patients (77%) received ECV.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) 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.

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.

No MeSH data available.


Related in: MedlinePlus