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Published on: February 26, 2013
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Electric Cardioversion vs. Pharmacological with or without Electric Cardioversion for Stable New-Onset Atrial
Paritosh Prasai1, Dhan Bahadur Shrestha2, Eltaib Saad1
1Department of Internal Medicine, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA.
Journal of Clinical Medicine
|February 11, 2023
Summary
Pharmacological cardioversion and electrical cardioversion show similar success rates for new-onset atrial fibrillation. This meta-analysis found no significant differences in outcomes for stable patients, with electrical cardioversion having lower hypotension rates.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- Lack of consensus exists regarding the preferred cardioversion method for hemodynamically stable new-onset atrial fibrillation (NOAF) patients in the emergency department (ED).
- Pharmacological cardioversion (PC) and electrical cardioversion (EC) are both utilized, necessitating a comparative analysis.
Purpose of the Study:
- To compare the efficacy and safety of pharmacological cardioversion (PC) versus electrical cardioversion (EC) for hemodynamically stable new-onset atrial fibrillation (NOAF) patients.
- To evaluate successful restoration of sinus rhythm and secondary outcomes including revisits, readmissions, length of stay, and adverse events.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies published up to March 7, 2022.
- Searched PubMed, PubMed Central, Embase, Scopus, and Cochrane databases.
- Primary outcome: successful sinus rhythm restoration; Secondary outcomes: ED revisits, hospital readmissions, length of stay, adverse events.
Main Results:
- No significant difference in successful sinus rhythm restoration rates between PC and EC (88.66% vs. 85.25%).
- No statistical differences observed in ED revisits, hospital readmissions, or length of stay.
- Electrical cardioversion (EC) was associated with a lower incidence of hypotension compared to pharmacological cardioversion (PC).
Conclusions:
- Pharmacological cardioversion (PC) and electrical cardioversion (EC) demonstrate comparable success rates for restoring sinus rhythm in hemodynamically stable new-onset atrial fibrillation (NOAF) patients.
- Neither method showed superiority regarding revisits, readmissions, or length of hospital stay.
- Electrical cardioversion (EC) may be preferred due to a lower risk of hypotension.
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