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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 5, September/October 2020
256
AFRICA
IV drugs can rapidly restore normal heart rhythm without sedation, shocks
Electrical and intravenous drug cardioversion were equally
efficacious in treating acute atrial fibrillation, found a large,
randomised, controlled trial.
A large, randomised, controlled trial looked at
cardioversion, a medical procedure that quickly brings heart
rhythm back to normal. Cardioversion can be done with
a mild electric shock or with fast-acting drugs delivered
through an IV. ‘These methods allow us to quickly get
patients back to their normal heart rate and send them home
after four to six hours in the emergency department,’ said
Dr Ian Stiell, lead author and senior scientist at the Ottawa
Hospital and distinguished professor at the University of
Ottawa.
Acute atrial fibrillation is a rapid, irregular heartbeat
that must be treated within 48 hours to avoid complications
such as stroke and heart failure. The study team estimates
that acute atrial fibrillation accounts for 430 000 emergency
department visits every year in Canada and the USA.
The researchers recruited 396 patients with acute atrial
fibrillation from 11 Canadian emergency departments.
Cardioversion is a commonly used treatment in this country.
Patients were randomly assigned to one of two kinds. The
first group received only electrical cardioversion. Patients
are sedated during this procedure, so they do not feel the
shock. The second group received a drug called procainamide
through an IV. If the drug did not reset the patient’s
heart rhythm within 30 minutes, they received electrical
cardioversion.
In the shock-only group (192 patients), 92% returned to
their normal heart rhythm (176) and 95% were discharged
home (183). In the drug-then-shock group (204 patients),
96% returned to their normal heart rhythm (196), 97% were
discharged home (198), and 52% recovered their normal
heart rhythm with the drug alone (106).
Both kinds of cardioversion were equally good at restoring
normal heart rhythm and getting patients home the same day.
The drug–shock strategy was more effective for patients
experiencing atrial fibrillation for the first time, and for
patients younger than 70 years.
The two methods were equally safe, none of the patients
had any serious side effects. Two weeks after the treatment, no
patients had had a stroke, 95% still had normal heart rhythm,
11% returned to the emergency department because of atrial
fibrillation, 3% had an additional round of cardioversion,
and 2% were admitted to hospital.
continued on page 273 …
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