Pharmacological cardioversion for atrial fibrillation and flutter

Area of Science:

• Cardiology
• Clinical Trials
• Pharmacology

Background:

• Atrial fibrillation (AF) is the most prevalent cardiac dysrhythmia, contributing to significant morbidity and mortality.
• Management strategies for AF include ventricular rate control and rhythm control via cardioversion.
• The comparative effectiveness of these AF management approaches requires thorough investigation.

Purpose of the Study:

• To evaluate the impact of pharmacological cardioversion of atrial fibrillation (AF) in adults.
• To assess the annual risks of stroke, peripheral embolism, and mortality associated with AF cardioversion.
• To compare rhythm control strategies against rate control in AF patients.

Main Methods:

• Systematic literature search of multiple databases (Cochrane, MEDLINE, EMBASE, CINAHL, Web of Science) and hand-searched journals.
• Inclusion of randomized controlled trials and controlled clinical trials comparing pharmacological cardioversion with rate control in adult AF patients.
• Data extraction and quality assessment performed by a single reviewer using RevMan software.

Main Results:

• Two major studies (AFFIRM and PIAF) involving 4060 and 252 patients, respectively, were analyzed.
• No significant difference in mortality was observed between rhythm control and rate control groups (RR 1.14, 95% CI 1.00 to 1.31).
• Rhythm control was associated with higher hospitalization rates and adverse events, with no improvement in quality of life; stroke incidence was similar between groups.

Conclusions:

• Pharmacological cardioversion to sinus rhythm offers no demonstrated superiority over rate control for atrial fibrillation (AF).
• Rhythm control strategies in AF are linked to increased adverse effects and hospitalizations, without reducing stroke risk.
• Findings may not be generalizable to all AF populations, particularly younger individuals without cardiovascular risk factors.