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Published on: February 26, 2013
Pharmacological Cardioversion Versus Electrical Cardioversion in the Acute Treatment of Atrial Fibrillation in the
Juan Jose López-Díaz1, Alejandro Manuel López-Pena2,3, Juliana Elices-Teja2,3
1Emergency Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain.
Insights
Electrical cardioversion (EC) is more effective than pharmacological cardioversion (PC) for restoring sinus rhythm in atrial fibrillation (AF) patients. EC demonstrates higher success rates and is recommended for emergency department patients with AF.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Atrial fibrillation (AF) management in emergency departments focuses on restoring sinus rhythm.
- Debate exists regarding the optimal strategy for cardioversion in stable AF patients.
Purpose of the Study:
- To compare the efficacy of pharmacological cardioversion (PC) and electrical cardioversion (EC) for AF.
- To evaluate rhythm control strategies in the emergency department setting.
Main Methods:
- Retrospective observational study of uncomplicated AF patients over four years.
- Comparison of PC (with or without subsequent EC) versus EC.
- Analysis of demographic and clinical variables.
Main Results:
- Electrical cardioversion (EC) achieved a 94.9% success rate, significantly higher than pharmacological cardioversion (PC) at 76.8%.
- EC demonstrated superior efficacy in converting patients to sinus rhythm (p = 0.0001).
- PC alone showed limited efficacy, often requiring additional interventions.
Conclusions:
- Electrical cardioversion (EC) is a safe and more effective strategy for restoring sinus rhythm in AF patients.
- Pharmacological cardioversion (PC) alone has limited efficacy for AF cardioversion.
- EC is recommended for patients requiring urgent rhythm control in the emergency department.
Abstract:
Background: Strategies to restore sinus rhythm in hemodynamically stable patients with atrial fibrillation (AF) admitted to the emergency department (ED) are the focus of debate. The present study was carried out to compare pharmacological cardioversion (PC) and electrical cardioversion (EC) in terms of their efficacy in converting to sinus rhythm. Methods: A retrospective, analytical observational study was carried out in patients seen in the ED over four consecutive years with episodes of uncomplicated AF. Two rhythm control strategies were evaluated: PC (followed or not by EC) and EC. Demographic and clinical variables were also compiled for both groups. Results: A total of 401 cardioversion procedures in 284 patients were analyzed. The mean patient age was 62.81 years (standard deviation [SD] 12.07), and 67.4% were male. PC was carried out in 160 subjects (56.3%), with a success rate of 76.8%, and EC was performed in 98 patients (34.5%), with a success rate of 94.9%. Significant differences between the two strategies were found for the primary objective (cardioversion to sinus rhythm), with the EC group presenting the best results (p = 0.0001). Conclusions: EC is safe and more effective in converting to sinus rhythm. The efficacy of PC alone is limited, and additional procedures for rhythm control are often required.
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