APPLIED PHARMACOLOGYImplementation of a Procainamide-Based Cardioversion Strategy for the Management of Recent-Onset Atrial FibrillationMatuskowitz, Andrew J. MD; Weant, Kyle A. PharmD, BCPS, BCCCP, FCCP; Gregory, Haili PharmD, BCPS; Field, Michael E. MD; Calhoun, Chara PharmD, BCPS; Bushkar, Brent J. MD; Hall, Gregory A. MD; Caporossi, Jeffrey MDEditor(s): Weant, Kyle A. PharmD, BCPS, BCCCP, FCCP, Column Editor Author Information Departments of Emergency Medicine (Drs Matuskowitz, Bushkar, Hall, and Caporossi) and Pharmacy Services (Dr Calhoun), Medical University of South Carolina, Charleston; Department of Clinical Pharmacy and Outcome Sciences, University of South Carolina College of Pharmacy, Columbia (Dr Weant); Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville (Dr Gregory); Division of Cardiology, Department of Internal Medicine, Medical University of South Carolina, Charleston (Dr Field); and Department of Clinical Pharmacy and Outcome Sciences, Medical University of South Carolina College of Pharmacy, Charleston (Dr Calhoun). Corresponding Author: Kyle A. Weant, PharmD, BCPS, BCCCP, FCCP, Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, University of South Carolina, CLS 316A, Columbia, SC 29208 ([email protected]). Disclosure: The authors report no conflicts of interest. Advanced Emergency Nursing Journal: July/September 2021 - Volume 43 - Issue 3 - p 186-193 doi: 10.1097/TME.0000000000000358 Buy CE Test Metrics Abstract Atrial fibrillation/flutter (AF) remains the most common rhythm disturbance in adult patients presenting to emergency departments (EDs). Although pharmacologic cardioversion has been established as safe and effective in recent-onset AF, its use in U.S. EDs is uncommon. The purpose of this study was to assess the safety and efficacy of intravenous (IV) procainamide for pharmacologic cardioversion in patients presenting to the ED with AF of <48-hr duration. Patients presenting to the ED with recent-onset AF (<48 hr) undergoing a cardioversion strategy with IV procainamide from 2017 to 2019 were reviewed. Clinical outcomes assessed included rates of cardioversion, hospital admission, stroke, and return ED visits for arrhythmia or serious adverse events. A total of 64 patients received procainamide therapy—60.9% achieved cardioversion and 35.9% were admitted to the hospital. The mean dose was 1062.4 mg (12.1 mg/kg). No patients returned to the ED secondary to stroke and 9.4% experienced complications attributed to procainamide, the most common being hypotension. Within 30 days of therapy, 20.3% of patients returned to the ED secondary to arrhythmia recurrence. Patients experiencing cardioversion with procainamide were less likely to be admitted to the hospital (25.6% vs. 52.0%; p = 0.04) or receive a rate control agent (17.9% vs. 64.0%; p = 0.001). There was no significant difference in the rate of 30-day return between those who experienced pharmacologic cardioversion and those who did not (p = 0.220). The implementation of a procainamide-based acute cardioversion strategy for patients presenting to the ED with recent-onset AF resulted in a 60% cardioversion rate, which was associated with a significantly higher rate of discharge from the ED. Transient hypotension was the most common adverse event. Further investigation into ED-based protocols for management of recent-onset AF is necessary to better understand their safety and efficacy. © 2021 Wolters Kluwer Health, Inc. All rights reserved.