Emergency department management and 1-year outcomes of patients with atrial flutter

Study objective: Atrial flutter is a common arrhythmia seen in the emergency department (ED), yet there is little research describing its management and outcomes. We analyze the success and safety of treatment of ED patients with atrial flutter.

Methods: This was a retrospective cohort study obtained by searching the ED administrative database of 2 urban hospitals to identify consecutive patients with a primary discharge diagnosis of atrial flutter from April 1, 2006, to January 31, 2009. We linked each patient's unique provincial health number to the provincial vital statistics registry and the regional ED database to identify subsequent deaths and strokes within 1 year. Manual chart review was conducted to confirm rhythms and outcomes and to identify patient comorbidities. Patients were stratified into 5 groups based on initial ED presentation and management approach: electrocardioversion, chemical cardioversion, spontaneous cardioversion, rate control only, and no acute ED arrhythmia-specific treatment. Primary outcome was the combined 1-year rate of stroke or death, and secondary outcomes included the proportion of eligible patients with conversion to normal sinus rhythm in each group and discharged to home.

Results: Data from 122 consecutive patients with a primary ED diagnosis of atrial flutter were collected; there were 3 deaths and no strokes (2.5%; 95% confidence interval 0% to 5.1%) in the following year. Patients undergoing electrocardioversion achieved normal sinus rhythm 91% of the time, with 93% discharged home; patients undergoing oral or intravenous antiarrhythmic treatment achieved sinus rhythm 27% of the time, with 60% discharged home. Discharge rates of patients with spontaneous cardioversion, rate control, and no ED treatment were 93%, 58%, and 96%, respectively.

Conclusion: In this 2-center cohort of ED patients with atrial flutter, patients eligible for rhythm control had a higher success and lower admission rate with electrocardioversion than patients treated with antiarrhythmic medications. Overall, the majority of patients were discharged home. Deaths were typically related to concurrent medical illness rather than atrial flutter.