Cardioversion of uncomplicated paroxysmal atrial fibrillation: a survey of practice by Canadian emergency physicians.

OBJECTIVE

Paroxysmal atrial fibrillation (PAF) is the rhythm disturbance most commonly encountered by emergency physicians, yet the role played by emergency physicians in the management of this condition has not been well described. The purpose of this study was to describe the management of uncomplicated PAF by Canadian emergency physicians.

METHODS

All members of the Canadian Association of Emergency Physicians with a Canadian address (n = 1255) were mailed a 15-point questionnaire regarding training/certification, hospital demographics and practice patterns regarding the management of uncomplicated PAF. Chi-squared analysis and Fisher's Exact test were performed to identify significant differences in reported practice patterns in relation to demographic variables. Significant associations were tested for interaction using the Mantel-Haenszel test.

RESULTS

We received 663 responses, representing a 52.8% response rate. Six hundred and twenty-two (95%), 514 (78%) and 242 (38%) respondents reported routine performance of rate control, chemical cardioversion and electrical cardioversion respectively. Physicians working in high-volume emergency departments (>50,000 visits/yr) were significantly more likely to self-manage rate control and chemical/electrical cardioversion than those working in lower volume emergency departments. Residency training was associated with higher performance of electrical (44% v. 31%, p < 0.01) but not chemical cardioversion or rate control, although, amongst residency trained physicians, those with FRCP-level training were significantly more likely to perform both chemical (86% v. 76%, p < 0.05) and electrical (57% v. 37%, p < 0.01) cardioversion.

CONCLUSION

Canadian emergency physicians surveyed in this study actively manage uncomplicated PAF. We found significant variations in practice, especially related to the use of electrical cardioversion. This may reflect different practice environments, levels of training, and lack of evidence to guide best practice. Further research is required to determine the optimal care of PAF in the emergency department setting.