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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
PubMed

Insights

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.
Abstract

Keywords:
cardioversionelectrical cardioversionnew-onset atrial fibrillationpharmacological cardioversion

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