Methods of sinus rhythm restoration in patients with persistent and long-standing persistent atrial fibrillation

The objective was to analyze modern approaches to the use of electrical and pharmacological cardioversion in patients with persistent atrial fibrillation (AF). Materials and methods. A non-systematic literature review was conducted. Russian publications were searched in the eLibrary database, and international publications were sourced from PubMed and Google Scholar. Results. Cardioversion in patients with persistent AF employs either electrical cardioversion (ECV) or pharmacological cardioversion with cavutilide. ECV demonstrates high efficacy and a low rate of adverse events. However, its effectiveness depends on patients’ constitutional characteristics. Additionally, ECV requires total intravenous anesthesia, which may lead to sedation-related adverse events. Pharmacological cardioversion with cavutilide shows comparable efficacy to ECV. Studies indicate a favorable safety profile for cavutilide; however, due to the risk of proarrhythmic events, strict adherence to administration protocols and extended post-procedural monitoring in intensive care unit are obligatory. Conclusion . The choice of the optimal method for restoring sinus rhythm in patients with persistent AF should be individualized.