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Effectiveness and costs of chemical versus electrical cardioversion of atrial fibrillation

Angelo A V de Paola1, Edilberto Figueiredo, Ricardo Sesso

  • 1Clinical Cardiac Electrophysiology, Paulista School of Medicine, Federal University of Sao Paulo, Rua Napoleão de Barros 593, ZIP 04024-002, São Paulo, Brazil. depaola@uol.com.br

International Journal of Cardiology
|April 26, 2003
PubMed

Insights

Starting atrial fibrillation cardioversion with antiarrhythmic drugs is more effective and less expensive than electrical cardioversion. Chemical cardioversion is a viable initial treatment for persistent atrial fibrillation, but carries risks for patients with heart disease.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Health Economics

Background:

  • Atrial fibrillation (AF) is a prevalent cardiac arrhythmia with significant healthcare costs.
  • Current interventions for AF to sinus rhythm include antiarrhythmic drugs and electrical cardioversion.
  • Optimal initial strategy for cardioversion remains undetermined.

Purpose of the Study:

  • To compare the effectiveness and cost-effectiveness of initial chemical versus electrical cardioversion for persistent atrial fibrillation.
  • To evaluate the overall success rates and complication profiles of different initial cardioversion strategies.

Main Methods:

  • A multicenter randomized trial involving 139 patients with persistent atrial fibrillation (duration < 6 months).
  • Comparison of initial treatment with chemical cardioversion versus electrical cardioversion.
  • Cross-over allowed if initial treatment failed to achieve sinus rhythm.

Main Results:

  • Initial cardioversion efficacy was comparable between chemical (74%) and electrical (73%) approaches (P=0.95).
  • The strategy of initiating with antiarrhythmic drugs demonstrated higher effectiveness (96%) versus electrical cardioversion (84%) (P=0.0016).
  • Chemical cardioversion was less expensive ($1240 vs. $1917; P=0.002) and associated with life-threatening complications in 5% of patients with structural heart disease.

Conclusions:

  • For persistent atrial fibrillation (< 6 months), initiating cardioversion with antiarrhythmic drugs is more effective and cost-effective than electrical cardioversion.
  • While initial chemical and electrical cardioversion show similar efficacy, drug-based initiation offers better outcomes.
  • Patients with structural heart disease undergoing chemical cardioversion face increased susceptibility to severe complications.
Abstract

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