Routine Unselected Access to Day Case Electrical Cardioversion of Persistent Atrial Fibrillation: Anticoagulant Preparation is the Key Factor

OBJECTIVES: To determine the routine efficacy of a day case cardioversion system operating in a remote geographical area with an unselected case referral base and a proportion of direct GP access. DESIGN: Prospective analysis of all admitted cases in a 13 week period. PARTICIPANTS: 47 consecutive patients admitted for 49 planned episodes of electrical cardioversion. MEASUREMENTS: Pre procedural investigations and preparation, immediate and three-month outcome of rhythm following ECV. RESULTS: We found a predominant use by the cardiac unit despite working within a general medical service unit suggesting low case selection from non-cardiac sources. We suspected and confirmed a high rate of point of care treatment cancellation. Poor management of anticoagulation was the dominant reason for canceling planned treatment. Procedural preparation in terms of anti arrhythmic drug therapy and investigations seemed well preserved. CONCLUSION: New strategies for initiating and sustaining adequate outpatient warfarin therapy are needed to allow such systems to operate efficiently.