Article Data

  • Views 2551
  • Dowloads 228

Original Research

Open Access

Factors related to the success or failure of cardioversion in atrial fibrillation and emergency department revisit according to restoration of sinus rhythm: analysis of the URGFAICS cohort

  • Irene Cabello1
  • Javier Jacob1,*,
  • Oriol Yuguero2
  • María Arranz3
  • Jorge-Alexis Guzmán4
  • Anna Moreno2
  • Paloma Francés4
  • Julia Santos3
  • Anna Esquerrà5
  • Álvaro Zarauza1
  • Josep-María Mòdol5
  • on behalf of URGFAICS Research Group

1Emergency Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain

2Emergency Department, Hospital Arnau de Vilanova, 25007 Lleida, Spain

3Emergency Department, Hospital de Viladecans, 08840 Barcelona, Spain

4Emergency Department, Hospital Universitari Joan XXIII de Tarragona, 43001 Tarragona, Spain

5Emergency Department, Hospital Universitari Germans Trias i Pujol de Badalona, 08916 Barcelona, Spain

DOI: 10.22514/sv.2022.020 Vol.19,Issue 2,March 2023 pp.39-47

Submitted: 17 December 2021 Accepted: 12 January 2022

Published: 08 March 2023

*Corresponding Author(s): Javier Jacob E-mail:


Rhythm control in atrial fibrillation (AF) improves haemodynamic status and symptoms. However, there are few data related to revisit of patients who have undergone cardioversion in the Emergency Department (ED). The aim of the study was to compare ED revisit within 30 days according to the effectiveness of cardioversion and analyse the variables related to effective cardioversion. We undertook a multicentre, observational, cohort study with a 30-day follow-up. Older adults with AF presenting to 5 EDs in Spain and undergoing cardioversion were included. The primary endpoint was revisit to the ED within 30 days, and univariate and multivariate analyses were carried out according to the effectiveness of cardioversion. We enrolled 336 patients who underwent cardioversion in the ED. Following the index visit, 7.4% revisited the ED within 30 days, with no differences with respect to the effectiveness of cardioversion (hazard ratio: 0.87; 95%confidence interval (CI) 0.31–2.43). In the multivariate study, AF lasting <48 hours was related to more effective cardioversion (adjusted odds ratio (aOR): 2.14; 95% CI 1.16–3.59) while the use of amiodarone (aOR: 0.52; 95% CI 0.27–0.99) and digoxin in ED (aOR: 0.28; 95% CI 0.13–0.66) was related to less effective cardioversion. In patients with AF undergoing a rhythm control strategy in the ED, the absence of restoration of sinus rhythm was not associated with a greater frequency of 30-day ED revisit.


Atrial fibrillation; Emergency department; Revisit; Sinus rhythm restoration; URGFAICS

Cite and Share

Irene Cabello,Javier Jacob,Oriol Yuguero,María Arranz,Jorge-Alexis Guzmán,Anna Moreno,Paloma Francés,Julia Santos,Anna Esquerrà,Álvaro Zarauza,Josep-María Mòdol,on behalf of URGFAICS Research Group. Factors related to the success or failure of cardioversion in atrial fibrillation and emergency department revisit according to restoration of sinus rhythm: analysis of the URGFAICS cohort. SignaVitae. 2023. 19(2);39-47.


[1] Staerk L, Wang B, Preis SR, Larson MG, Lubitz SA, Ellinor PT, et al. Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham heart study. The BMJ. 2018; 361: k1453.

[2] Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019; 139: e56–e528.

[3] Coll-Vinent B, Fuenzalida C, Garcia A, Martin A, Miró O. Management of acute atrial fibrillation in the emergency department: a systematic review of recent studies. European Journal of Emergency Medicine. 2013; 20: 151–159.

[4] Cohen M, Naccarelli GV. Pathophysiology and disease progression of atrial fibrillation: importance of achieving and maintaining sinus rhythm. Journal of Cardiovascular Electrophysiology. 2008; 19: 885–890.

[5] Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, et al. Early rhythm-control therapy in patients with atrial fibrillation. New England Journal of Medicine. 2020; 383: 1305–1316.

[6] Willems S, Meyer C, de Bono J, Brandes A, Eckardt L, Elvan A, et al. Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation. European Heart Journal. 2019; 40: 3793–3799c.

[7] Wyse DG, Waldo AL, Dimarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. The New England Journal of Medicine. 2002; 347: 1825–1833.

[8] Cohn BG, Keim SM, Yealy DM. Is emergency department cardioversion of recent-onset atrial fibrillation safe and effective? The Journal of Emergency Medicine. 2013; 45: 117–127.

[9] Hindricks G, Potpara T, Dagres N, Arbelo E., Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2021; 42: 373–498.

[10] Osmanagic A, Möller S, Osmanagic A, Sheta HM, Vinther KH, Egstrup K. Effect of early direct current cardioversion on the recurrence of atrial fibrillation in patients with persisten atrial fibrillation. The American journal of cardiology. 2015; 116: 225–229.

[11] Klein AL, Grimm RA, Jasper SE, Murray RD, Apperson-Hansen C, Lieber EA, et al. Efficacy of transesophageal echocardiography-guided cardioversion of patients with atrial fibrillation at 6 months: a randomized controlled trial. American Heart Journal. 2006; 151: 380–389.

[12] Dorian P, Cvitkovic SS, Kerr CR, Crystal E, Gillis AM, Guerra PG, et al. A novel, simple scale for assessing the symptom severity of atrial fibrillation at the bedside: the CCS-SAF scale. Canadian Journal of Cardiology. 2006; 22: 383–386.

[13] Jacob J, Cabello I, Yuguero O, Alexis Guzmán J, Arranz Betegón M, Abadías MJ, et al. Emergency Atrial Fibrillation Registry of the Catalan Institute of Health (URGFAICS): analysis by type of atrial fibrillation and revisits within 30 days. Emergencias. 2019; 31: 99–106.

[14] Wynn GJ, Todd DM, Webber M, Bonnett L, McShane J, Kirchhof P, et al. The european heart rhythm association symptom classification for atrial fibrillation: validation and improvement through a simple modification. Europace. 2014; 16: 965–972.

[15] Coll-Vinent B, Martín A, Sánchez J, Tamargo J, Suero C, Malagón F, et al. Benefits of Emergency Departments’ Contribution to Stroke Prophylaxis in Atrial Fibrillation: The EMERG-AF Study (Emergency Department Stroke Prophylaxis and Guidelines Implementation in Atrial Fibrillation). Stroke. 2017; 48: 1344–1352.

[16] Martín A, Coll-Vinent B, Suero C, Fernández-Simón A, Sánchez J, Varona M, et al. Benefits of rhythm control and rate control in recent-onset atrial fibrillation. the HERMES-AF study. Academic Emergency Medicine. 2019; 26: 1034–1043.

[17] del Arco C, Martín A, Laguna P, Gargantilla P. Analysis of current management of atrial fibrillation in the acute setting: gefaur-1 study. Annals of Emergency Medicine. 2005; 46: 424–430.

[18] Rosychuk RJ, Graham MM, Holroyd BR, Rowe BH. Emergency department presentations for atrial fibrillation and flutter in Alberta: a large population-based study. BMC Emergency Medicine. 2017; 17: 2.

[19] Stiell IG, Sivilotti MLA, Taljaard M, Birnie D, Vadeboncoeur A, Hohl CM, et al. Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomised trial. The Lancet. 2020; 395: 339–349.

[20] Carbajosa-Dalmau J, Martín A, Paredes-Arquiola L, Jacob J, Coll-Vinent B, Llorens P. Safety of emergency-department electric cardioversion for recent-onset atrial fibrillation. emergencias. 2019; 31: 335–340.

[21] Schmidt AS, Lauridsen KG, Møller DS, Christensen PD, Dodt KK, Rickers H, et al. Anterior–lateral versus anterior–posterior electrode position for cardioverting atrial fibrillation. Circulation. 2021; 144: 1995–2003.

[22] Stiell IG, Clement CM, Rowe BH, Brison RJ, Wyse DG, Birnie D, et al. Outcomes for emergency department patients with recent-onset atrial fibrillation and flutter treated in canadian hospitals. Annals of Emergency Medicine. 2017; 69: 562–571.e2.

[23] Fernández A, Coll-Vinent B, Martín A, Suero C, Sánchez J, Varona M, et al. Cardioversion in recent onset atrial fibrillation. Emergencias. 2019; 31: 227–233.

[24] Crijns HJ, Weijs B, Fairley AM, Lewalter T, Maggioni AP, Martín A, et al. Contemporary real life cardioversion of atrial fibrillation: Results from the multinational RHYTHM-AF study. International Journal of Cardiology. 2014; 172: 588–594.

[25] Conti A, Del Taglia B, Mariannini Y, Pepe G, Vanni S, Grifoni S, et al. Management of patients with acute atrial fibrillation in the ED. The American Journal of Emergency Medicine. 2010; 28: 903–910.

[26] Pluymaekers NAHA, Dudink EAMP, Luermans JGLM, Meeder JG, Lenderink T, Widdershoven J, et al. Early or delayed cardioversion in recent-onset atrial fibrillation. New England Journal of Medicine. 2019; 380: 1499–1508.

[27] McGrath P, Kersten B, Chilbert MR, Rusch C, Nadler M. Evaluation of metoprolol versus diltiazem for rate control of atrial fibrillation in the emergency department. The American Journal of Emergency Medicine. 2021; 46: 585–590.

[28] Cabello I, Jacob J, Arranz M, Yuguero O, Guzman J, Moreno-Pena A, et al. Impact of emergency department management of atrial fibrillation with amiodarone on length of stay. A propensity score analysis based on the URGFAICS registry. European Journal of Emergency Medicine. 2020; 27: 429–435.

[29] Camm AJ, Capucci A, Hohnloser SH, Torp-Pedersen C, Van Gelder IC, Mangal B, et al. A randomized active-controlled study comparing the efficacy and safety of vernakalant to amiodarone in recent-onset atrial fibrillation. Journal of the American College of Cardiology. 2011; 57: 313–321.

[30] Carbajosa Dalmau J, Cosín-Sales J, Pérez-Durá MJ, Urtubia-Palacios A, Hernández-Sori N, Peiró-Gómez A, et al. Vernakalant in hospital emergency practice: safety and effectiveness. Emergencias. 2017; 29: 397–402. (In Spanish)

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time