Effectiveness and Safety of Internal with Implantable Cardioverter-Defibrillator Versus External Cardioversion of Atrial Fibrillation

Internal cardioversion (ICV) and external cardioversion (ECV) are two commonly used methods of electrocardioversion; however, the optimal method for the treatment of atrial fibrillation (AF) is yet unknown. This systematic review evaluates and compares the safety and efficacy of ICV and ECV with AF through a meta-analysis. Systematic reviews were retrieved from Medline, PubMed, Embase, Cochrane libraries, and ScienceDirect databases. All clinical trials comparing the CV of AF with ICV and ECV were screened and included if the inclusion criteria were fulfilled. Four clinical trials, encompassing a total of 429 patients, were included in this meta-analysis. ECV, as compared to ICV, has an advantage of over converting AF to sinus rhythm ( P = 0.01). In terms of the CV of atrial arrhythmias, a subgroup analysis was performed. High statistical heterogeneity was observed in the analysis, and it was found that baseline heart failure was the main reason for the high heterogeneity. Compared to ICV, ECV is more effective in AF or atrial arrhythmia CV.