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.

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).

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.

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.