Limitations
This study had several limitations. This was a retrospective study and
there was no recorded reason for the decision as to where to undertake
the cardioversion, nor were there data on the reasons to extend patient
stay in the cardiology ward. There may have been patient differences not
recorded in the data, or it may simply have been a matter of bed
allocation.
One of the original study intentions was to collect sedation data along
with immediate post-procedure complication data to see if these were
related to the sedation or the procedure, but this data was scarce and
was therefore ultimately not included in the study. Thus, post-procedure
complication data should be cautiously interpreted. Regression analysis
was not performed on the data, as most data were similar between the
groups.
Many emergency departments may have a policy of automatically admitting
patients with AF > 48 hours to a cardiology ward rather
than treating them in the ED or an observation unit. Finally, the study
was performed in one tertiary care medical center including a
comprehensive cardiac institute, where the practice of ordering a TEE
through the ED may not be generalizable to other institutions. Further
prospective studies, perhaps of a randomized control design, would be
better able to elucidate the safety and efficacy of performing TEE prior
to electrical cardioversion of AF > 48 hours’ duration in
the ED setting.