Table 1

Summary of 8 sections of eCRF and site questionnaire
Site Questionnaire Enrollment Demographics Information on AF Medical treatment Prior to enrollment Diagnostic Procedures Acute Treatment of AF Discharge Follow-up at 60 days
Center characteristics (type, size, units) Demographics (age, gender, ethnicity) Anthropometrics (ht, wt, bp) Current episode (symptoms, type, time of onset, triggers) ATT, rate control, other (type, indication, dose) Laboratory measures (Hg, K, sCr, PG, INR-T) AA/Rate control (type, dose), Basics (vital status, date, time, destination) Contact information (mode, date)
Specialties at site (clinics, physicians, number and availability, procedures available) Admission information (date, time, site, reason) Medical history (CVD, CHF, details thereof) History of AF (date, frequency, nature, treatment) ECG (rhythm, rate, PR & QT interval, QRS duration, LVH) PCV & ECV (labs before, after, type, dose/joules & number of shocks route, worked?, time to SR, SR after) Rhythm at discharge; LoS by unit Basics (vital status, current rhyuthm)
Most frequent and most preferred approach to cardioversion ECG information (date, time, results) History of risk factors (family hx of disease, DM, smoking, htn, hyperlipidemia) TTE (LA size, LVEDD, LV-EF, LVH) Catheter ablation (type, technique, location, status), pacemaker, ICD implantation (type, indication) Complications and AEs experienced (specified, date) Recurrence and rehospitalization since discharge (date, LoS, documentation, CV info., reason)
Other comorbidities TEE (findings) Surgery (time, date, location, technique) Discharge medications (type, dose, indication) Complications and AEs experienced (specified, date)
Chest X-Ray, Stress test, Holter ECG, MRI, CT exam Discharge medications (type, dose, indication)

eCRF: electronic case report form; AF: atrial fibrillation; ht: height; wt: weight; bp: blood pressure; ATT: antithrombotic treatment; Hg: mercury; K: potassium; sCr: serum creatinine; PG: plasma glucose; INR-T: International Normalized Ratio (Prothombin Time); CVD: cardiovascular disease; CHF: congestive heart failure; ECG: electrocardiogram; PCV: pharmacologic cardioversion; ECV: electrical cardioversion; SR: sinus rhythm; LoS: length of stay; DM: diabetes mellitus; TTE: transthoracic echocardiogram; LA: left atrium; LVEDD: left ventricular end diastolic diameter; LV-EF: left ventricular ejection fraction; LVH: left ventricular hypertrophy; ICD: implantable cardioverter-defibrillator; AEs: adverse events; TEE: transesophageal echocardiogram; MRI: magnetic resonance imaging.

Crijns et al.

Crijns et al. BMC Cardiovascular Disorders 2012 12:85   doi:10.1186/1471-2261-12-85

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