This review highlights the various methods of electrical cardioversion for atrial fibrillation, noting external DC cardioversion as the standard and discussing alternatives like esophageal and internal cardioversion.
External DC cardioversion remains first-line for AF rhythm restoration; review leaves comparative efficacy of esophageal and internal alternatives open to prospective trials.
Atrial fibrillation is the most common cardiac arrhythmia observed in clinical practice. Many different therapeutic approaches are available at present but none may be considered the gold standard treatment. Antiarrhythmic drugs are not very effective agents to cardiovert persistent atrial fibrillation and, therefore, the technique most frequently used to restore sinus rhythm is external direct current cardioversion, which has proved to be safe and very effective. Esophageal cardioversion is an alternative method that could obviate some of the limitations of the external technique, such as the high energy required, need for anesthesia and longer hospital stay. Another technique performed during the last two decades is internal cardioversion, but at present, the advantage of this technique is limited to the small proportion of cases of unsuccessful external cardioversion.
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Santini et al. (2005) studied this question.
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