Electrical cardioversion for atrial fibrillation in the emergency department: A large single-center experience.

OBJECTIVE: Electrical cardioversion of ED patients is a well-described treatment strategy for certain patients presenting with atrial fibrillation (AF). The objective of this study was to describe the safety and outcomes of this practice in a cohort of patients undergoing ED electrical cardioversion for AF. METHODS: This retrospective health records survey investigated a 5-year cohort of consecutive ED patients presenting with AF who underwent electrical cardioversion in an academic, tertiary ED. Electronic and manual abstraction strategies were used, extracting data on demographics, clinical features, interventions, complications, and return visits within 1 month. Data were analyzed using descriptive statistics and agreement between trained abstractors on key variables was excellent (k = 0.94-0.98). RESULTS: Data from 887 patients were analyzed. Electrical cardioversion was successful in 781 (88%) encounters. There were 3 major complications (3/887; 0.3%) and 123 minor complications (123/887; 14%). Major complications included one post-cardioversion stroke (1/887; 0.1%), one jaw thrust maneuver for hypoxia (0.1%), and one overnight observation for hypotension (0.1%). 741 patients (84%) were discharged following cardioversion with a mean ED LOS of 218 min (95% CI: 206-231 min). 57 (6.4%) patients returned to the ED within 30 days; 43 (4.8%) returned with in AF or flutter. CONCLUSIONS: In this cohort of ED patients with atrial fibrillation, ED electrical cardioversion followed by discharge to home was largely safe and effective. Most complications were transient and mild. There were remarkably few serious complications.

Spleen and retroperitoneum: the essentials.

This is a survey of normal variants and pathologic conditions involving the spleen and retroperitoneum. The study focuses on the various sonographic appearances of trauma, infection, and neoplasm involving these areas in an attempt to complement works dealing specifically with the pancreas, kidneys, and great vessels. Ultrasound-guided intervention (biopsy, drainage) is included.

Comparison of iodixanol with iohexol for delayed pelvic venous opacification: a preliminary study of potential use for CT venography.

OBJECTIVE: The goal of this prospective randomized study was to determine whether isosmolar contrast material offers an advantage over low-osmolar contrast material for delayed venous opacification in CT venography. SUBJECTS AND METHODS. We prospectively enrolled 200 adult outpatients. Patients were randomized to receive either the low-osmolar (hyperosmolar to blood) nonionic contrast medium, iohexol, or the nonionic isosmolar contrast medium, iodixanol. Images were obtained before contrast administration and 180 sec after contrast administration through the pelvis at the level of the external iliac vessels. Opacification of the external iliac vessels was assessed both objectively and subjectively. RESULTS: The arterial and venous densities before contrast administration were approximately 45 H for both groups. On delayed images obtained after contrast administration, the mean venous density was 95.2 H for iohexol and 101.4 H for iodixanol. Changes in venous density due to administration of iohexol and iodixanol were 49.8 and 56.1 H, respectively. This 12.5% difference was highly significant (p = 0.002). Sixty-six percent of the images in the iodixanol group were rated either 4 (good) or 5 (excellent), whereas only 36% of the iohexol group achieved a similar rating on our subjective rating scale. This difference was statistically significant (chi(2) = 16.4, p < 0.001, df = 1). CONCLUSION: Our study shows that isosmolar contrast material provides significant improvement in delayed opacification of the external iliac vessels in comparison with conventional low-osmolar contrast medium (hyperosmolar to blood).