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Review paper

Breaking habits: safety and efficacy of elective electrocardioversion of atrial fibrillation and atrial flutter in the setting of day hospital

By
Ammar Brkić Orcid logo ,
Ammar Brkić

Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Minela Bećirović ,
Minela Bećirović
Contact Minela Bećirović

Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Emir Bećirović ,
Emir Bećirović

Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Tarik Brkić ,
Tarik Brkić

Clinic of Invasive Cardiology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Esad Brkić ,
Esad Brkić

Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Denis Mršić ,
Denis Mršić

Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Amir Bećirović ,
Amir Bećirović

School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina

Amila Jašarević ,
Amila Jašarević

Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Emir Softić ,
Emir Softić

Department of Emergency Medicine, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Alma Mujić Ibralić
Alma Mujić Ibralić

Health centre Živinice, Živinice, Bosnia and Herzegovina

Abstract

Aim
To examine safety and efficiency of electrocardioversion (EC) in elective treatment of atrial fibrillation and atrial flutter in
the setting of Day Hospital by determining success rate, frequency of adverse events and possible cost benefit compared to admitting a patient into hospital.
Methods
This prospective observational cohort study was performed in Day Hospital and in Intensive Care Department of Internal
Medicine Clinic, University Clinical Centre Tuzla from January 2019 to December 2022 and included 98 patients with a persistent form of atrial fibrillation (AF) or atrial flutter. The patients who were divided in two groups, 56 hospitalized and 42 patients accessed in Day Hospital. In all patients, medical history, physical examination, electrocardiogram (ECG) and transthoracic echocardiogram (TTE) evaluation was performed in addition to laboratory findings. Electrocardioversion was performed with a monophasic General Electric defibrillator in anterolateral electrode position with up to three repetitive shocks.
Results
In hospital setting group overall succes rate of electrocardioversion was 85%, with average 2.1 EC attemps, there was with one fatal outcome due to stroke, one case of ventricular fibrillation (VF) due to human error, and 6 minor adverse events; with average cost of was 1408.70 KM (720.23 €) per patient. In Day Hospital setting succes rate was 88%, with average 2 EC attempts, no major adverse events, 8 minor adverse events; and average cost was of 127.23 KM (65.05 €) per patient.
Conclusion
Performing elective electrocardioversion in Day Hospital setting is as safe as admitting patients into hospital but substantially more cost effective.

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