Study design and setting
This is a retrospective observational study of patients who presented to
the ED between January 1, 2010, and December 31, 2018, with a diagnosis
of AF for > 48 hours who then underwent a TEE. All of the
TEEs were ordered from the ED, but the actual examination was performed
by a board-certified cardiologist with additional training and extensive
experience with this procedure. Of the patients who did not have an
atrial clot or other contraindication to cardioversion, there was a
convenience sample who returned to the ED for electrical cardioversion
performed by emergency physicians versus a second group who were
cardioverted in the cardiology department. Regardless of the place where
electrical cardioversion was performed, all patients were sedated for
the procedure and received anticoagulation both before and after their
cardioversion as per protocol. The study site is a 1000-bed tertiary
care medical center that includes a comprehensive cardiology department.
Over 90,000 adult patients are seen annually in the ED. The
Institutional Review Board waived the requirement for written consent as
this was a retrospective study.