Key result
Electrical cardioversion shows no significant benefit over pharmacological cardioversion for restoring sinus rhythm in new-onset AF.
Why the study?
There is no clear consensus on whether pharmacological cardioversion or electric cardioversion is preferred for hemodynamically stable new-onset atrial fibrillation in the emergency department.
Does pharmacological cardioversion improve successful restoration of sinus rhythm compared to electric cardioversion in hemodynamically stable new-onset atrial fibrillation patients presenting to the ED?
Meta-Analysis (n=1,101)
Does pharmacological cardioversion improve successful restoration of sinus rhythm compared to electric cardioversion in hemodynamically stable new-onset atrial fibrillation patients presenting to the ED?
Pharmacological and electric cardioversion are equally effective for restoring sinus rhythm in hemodynamically stable new-onset atrial fibrillation in the ED, though electric cardioversion is associated with a lower risk of hypotension.
Supports either strategy for sinus rhythm restoration in stable new-onset AF; leaves open optimal selection given wide CI and few trials.
Background: There is no clear consensus on the preference for pharmacological cardioversion (PC) in comparison to electric cardioversion (EC) for hemodynamically stable new-onset atrial fibrillation (NOAF) patients presenting to the emergency department (ED). Methods: A systematic review and meta-analysis was conducted to assess PC (whether being followed by EC or not) vs. EC in achieving cardioversion for hemodynamically stable NOAF patients. PubMed, PubMed Central, Embase, Scopus, and Cochrane databases were searched to include relevant studies until 7 March 2022. The primary outcome was the successful restoration of sinus rhythm, and secondary outcomes included emergency department (ED) revisits with atrial fibrillation (AF), hospital readmission rate, length of hospital stay, and cardioversion-associated adverse events. Results: A total of three randomized controlled trials (RCTs) and one observational study were included. There was no difference in the rates of successful restoration to sinus rhythm (88.66% vs. 85.25%; OR 1.14, 95% CI 0.35–3.71; n = 868). There was no statistical difference across the two groups for ED revisits with AF, readmission rates, length of hospital stay, and cardioversion-associated adverse effects, with the exception of hypotension, whose incidence was lower in the EC group (OR 0.11, 95% CI 0.04–0.27: n = 727). Conclusion: This meta-analysis suggests that there is no difference in successful restoration of sinus rhythm with either modality among patients with hemodynamically stable NOAF.
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Prasai et al. (2023) conducted a meta-analysis in Hemodynamically stable new-onset atrial fibrillation (n=1,101). Electrical cardioversion vs. Pharmacological cardioversion with or without electrical cardioversion was evaluated on Successful restoration of sinus rhythm (OR 1.14, 95% CI 0.35-3.71). Electrical cardioversion showed no significant difference in successfully restoring sinus rhythm compared to pharmacological cardioversion (88.66% vs. 85.25%; OR 1.14) in patients with hemodynamically stable new-onset atrial fibrillation.
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