Is there a role for cardioversion in the management of atrial fibrillation?

Electrical cardioversion was originally used for the treatment of ventricular arrhythmias but has increasingly been used for atrial fibrillation in an attempt to restore sinus rhythm and correct the electrophysiological abnormalities associated with arrhythmias. Data have now accumulated demonstrating that cardioversion confers no survival benefit compared with a rate-control strategy and that even in patients who are successfully converted into sinus rhythm, oral anticoagulation needs to be maintained owing to the high rate of relapse. This is true for high-risk patients, such as those who also suffer from heart failure. Cardioversion should be reserved for patients with acute onset of atrial fibrillation and those who remain symptomatic despite medical therapy.