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Comparison of outpatient vs inpatient direct current cardioversion of atrial fibrillation: safety, efficacy and cost savings

G. Grönefeld, J.R. Ehrlich and S.H. Hohnloser*

Department of Medicine, Division of Cardiology, J. W. Goethe University, Frankfurt am Main, Germany

* Stefan H. Hohnloser, MD, FESC, FACC, Department of Medicine, Division of Cardiology, J. W. Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.

Abstract

Aim: Although electrical cardioversion (CV) of atrial fibrillation (AF) is frequently performed, there is a lack of data regarding the setting in which this procedure is most appropriate. This prospective, observational study compared efficacy, safety and costs of inpatient vs outpatient electrical CV of AF.

Methods and results: Feasibility and treatment related costs of inpatient vs outpatient direct current (DC) CV of AF were evaluated in a series of 185 consecutive procedures with individual follow-up at 28 days after DC CV. Success rate, complications and duration of hospital stay were analyzed for 97 consecutive inpatient procedures and subsequently for 88 outpatient procedures. Both groups were similar with respect to the relevant clinical characteristics. Restoration of sinus rhythm was achieved in 79 of the 97 inpatients (81%) and 75 of the 88 outpatients (85%). No severe complications were observed in the outpatient group. Three incidences of cerebral stroke occurred after 2–6 days in the group of patients treated in hospital, two of these after discontinuation of anticoagulation therapy. Procedure related hospital stay averaged 6 h for outpatients, as compared with 40 h for inpatients. Procedure related costs were reduced by approximately US$600–700 per patient when DC CV was performed on an outpatient basis.

Conclusion: Outpatient DC CV of AF is safe and effective, and results in a significant reduction in procedure related costs.

Key Words: Atrial fibrillation • Costs • Direct current Cardioversion • Outpatient treatment


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