WITHDRAWN: Pharmacological cardioversion for atrial fibrillation and flutter

Area of Science:

• Cardiology
• Clinical Trials
• Pharmacology

Background:

• Atrial fibrillation is the most common cardiac dysrhythmia, linked to significant morbidity and mortality.
• Management strategies include ventricular rate control or rhythm conversion to sinus rhythm.
• The study evaluates the impact of pharmacological cardioversion on atrial fibrillation management.

Purpose of the Study:

• To assess the effects of pharmacological cardioversion of atrial fibrillation in adults on the annual risk of stroke, peripheral embolism, and mortality.
• To compare the efficacy and safety of rhythm control versus rate control strategies.

Main Methods:

• Systematic review of randomized controlled trials and controlled clinical trials.
• Searched multiple databases (Cochrane, MEDLINE, EMBASE, CINAHL, Web of Science) and hand-searched key cardiology journals.
• Included adults (>18 years) with atrial fibrillation or flutter of any duration or etiology.

Main Results:

• Two studies (AFFIRM, PIAF) involving 4312 participants were analyzed.
• No significant difference in mortality between rhythm control and rate control groups (RR 1.14, 95% CI 1.00-1.31).
• Rhythm control was associated with higher hospitalization rates, adverse events, and malignant dysrhythmias, with no improvement in quality of life or stroke risk.

Conclusions:

• Pharmacological cardioversion to sinus rhythm is not superior to rate control for atrial fibrillation.
• Rhythm control increases adverse effects and hospitalizations without reducing stroke risk.
• Findings may not apply to all patients, particularly younger individuals without cardiovascular risk factors.