欧博百家乐How Long Should Patients Be Monitored Followi
Perspective > Medscape Nurses > Ask the Experts > Cardiology for Advanced Practice Nurses
How Long Should Patients Be Monitored Following Outpatient Cardioversion?
W. Lane Edwards, Jr, MSN, ARNP, ANP; William Lane Edwards, Jr., MSN, ARNP, ANP
September 27, 2006
Question
Should it be a standard of care to use telemetry or cardiac monitoring after outpatient cardioversion for atrial fibrillation? If so, how long should monitoring be continued?
Response From the Expert
Nurse Practitioner, Internal Medicine, Lee County Internal Medicine Associates, Fort Myers, Florida
Outpatient cardioversion of atrial arrhythmias is a low-risk, effective, and economical procedure.[] In a retrospective analysis of outpatient cardioversion of 532 consecutive patients performed over a 5-year period in an academic medical center, 98% of patients were discharged in sinus rhythm following the procedure.[] Of 11 unplanned admissions in this study, bradycardia developed in 4 patients and transient pacemaker noncapture occurred in another 4 patients. Transient postshock rhythms also included AV nodal Wenckeback and junctional rhythms, none of which were life-threatening.[] In another study of 185 consecutive outpatient cardioversions, only 1 patient demonstrated a temporary sinus bradycardia in the postconversion period.[]
The 2006 American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) Practice Guidelines for the Management of Atrial Fibrillation state that various benign arrhythmias (ventricular and supraventricular premature beats, bradycardia, and short periods of sinus arrest) may arise after cardioversion but commonly subside spontaneously.[]
A comprehensive preprocedural evaluation will identify the most common causes of significant dysrhythmias that might manifest in the immediate postcardioversion period. The advanced practice nurse should be aware that patients with hypokalemia, digitalis intoxication, or improper synchronization may demonstrate more serious arrhythmias following cardioversion. These may include ventricular tachycardia, protracted bradyarrhythmias, and ventricular fibrillation. Patients with long-standing atrial fibrillation and a slow ventricular response, in the absence of drugs, may have underlying sinus node dysfunction.[]
It is my opinion that telemetry monitoring should be continued until the following discharge criteria are met:
A return of oxygen saturation to baseline;
Stable vital signs;
Return of level of consciousness to baseline; and
Return of baseline ambulation capacity.[]
The likelihood that a patient will demonstrate postcardioversion arrhythmias after this time is currently unknown.
Medscape Nurses. 2006;8(2) © 2006 Medscape
Cite this: William Lane Edwards. How Long Should Patients Be Monitored Following Outpatient Cardioversion? - Medscape - Sep 25, 2006.
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Authors and Disclosures
Authors and Disclosures
Disclosure: W. Lane Edwards, Jr, MSN, ARNP, ANP, has disclosed that he has received grants for educational activities from AstraZeneca, Scienta Healthcare, and Ortho McNeil Neurosciences. Mr. Edwards has also disclosed that he has served an advisor or consultant to AstraZeneca, Scienta Healthcare, GlaxoSmithKline, Roche, Johnson & Johnson, and Ortho McNeil Neurosciences. Mr. Edwards has also disclosed that he serves on the speaker's bureaus of AstraZeneca, Scienta Healthcare, Merck-Merck Schering Plough, GlaxoSmithKline, Roche, Johnson & Johnson, Ortho McNeil Neurosciences, and KOS.
Author(s) William Lane Edwards, Jr, MSN, ARNP, ANP
W. Lane Edwards, Jr., MSN, ARNP, ANP, Lecturer, University of Alaska, Anchorage, Alaska; Lecturer, Florida Gulf Coast University, Fort Myers, Florida; Consultant, Graduate Family Nurse Practitioner Program, University of South Alabama, Mobile, Alabama
Suggested Reading
Suggested Reading I
Aizer A, Fuster V. Atrial fibrillation: management. ACP Medicine Online, 2002. Available at: https://www.medscape.com/viewarticle/535333. Accessed September 20, 2006.