[How and when to use cardioversion in atrial fibrillation at the beginning of the year 2000]

The high incidence and associated complications are causing atrial fibrillation to emerge as a disease of uncertain prognosis, rather than an acceptable alternative to sinus rhythm. There is accumulated evidence of an electrical and anatomical remodelling in atrial fibrillation that facilitates the onset and maintenance of this arrhythmia, and the capacity for these changes may be reversed if sinus rhythm is restored. The development of new drugs that decrease the incidence of recurrences and the advent of internal cardioversion, which has proven to be very effective when traditional methods have failed, have widened the indications and increased the number of patients who may benefit from this technique. These advances pave the way for the development of an implantable atrial cardioverter, which would allow an early treatment of atrial fibrillation and, therefore, lessen the deleterious effects brought on by this rhythm disorder.