[Current aspects of electrical cardioversion in patients with persistent atrial fibrillation]

Results of recent studies suggest new aspects in the concept of the management of patients with atrial fibrillation. Current trials comparing rhythm control by cardioversion followed by antiarrhythmic drug therapy with heart rate control only showed that rhythm control was not superior to rate control.

However, some subgroups of patients with frequent or severe symptoms and younger patients with structurally normal hearts may benefit from cardioversion. In patients with persistent atrial fibrillation, sinus rhythm can be restored in approximately 90% by direct current transthoracic cardioversion. Transthoracic cardioversion is effective and safe, if anticoagulation is used. Attempts have been made to improve the success rate by new techniques. However, definition of subgroups and stabilization of sinus rhythm are ongoing issues of debate.