Elective Cardioversion of Atrial Fibrillation at Home by Advanced Practice Providers: A Feasibility Study in the Dutch Emergency Medical Service - Design and Pilot Results

AIM: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. Cardioversion for AF is indicated to improve symptoms and haemodynamic status. Patients with persistent AF requiring direct current electrical cardioversion (DC-ECV) present a significant challenge to the cardiology department. Hospital at Home represents a paradigm shift in the standard way of delivering acute care. Encouraged by these possibilities and benefits, the cardiology department of the Jeroen Bosch Hospital and the local emergency medical service RAV Brabant MWN raised the question of whether DC-ECV treatment can be carried out at home instead of in an inpatient setting. This pilot study aims to investigate whether home-based cardioversion is feasible. METHODS AND RESULTS: ELECTRA-1 is a single-centre, prospective feasibility study of home-based ECV in haemodynamically stable AF patients requiring cardioversion. The APP-led home-based DC-ECV was carried out by advanced practice providers (APPs) of the emergency medical service RAV Brabant MWN supported by an ambulance team consisting of an ambulance nurse and driver both trained in advanced live support. Thirty-eight patients gave their consent, and 26 (68%) had a home DC-ECV. In 23 (88%) cases, the DC-ECV was successful, and sinus rhythm was achieved. Twelve (32%) cases had a spontaneous return to sinus rhythm. No early or late major adverse cardiovascular and cerebrovascular event was reported for these 26 patients. CONCLUSION: Performing DC-ECV at home is feasible. This study did not examine the safety of doing so but did find a high level of satisfaction among the participating patients. REGISTRATION: ClinicalTrials.gov ID NCT06322836.