Success of serial external electrical cardioversion of persistent atrial fibrillation in maintaining sinus rhythm. A randomized study

Abstract

These results demonstrate that an aggressive policy towards persistent atrial fibrillation by means of repetition of electrical cardioversion after early atrial fibrillation recurrence is useful in maintaining sinus rhythm after 12 months.

Persistent atrial fibrillation: rate control or rhythm control

“…However, most current anti-arrhythmic drugs have limited efficacy and several side effects. With the use of anti-arrhythmics and serial electrical cardioversion for early relapse up to 53% of patients are in sinus rhythm at one year,5 but only 25% remain so at five years 6. Considerable controversy therefore exists as to whether rhythm or rate control is the more appropriate management for most patients with persistent atrial fibrillation.…”

Pharmacotherapy for atrial fibrillation: is rhythm control achievable?

“…In an analysis of factors independently predicting survival in the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial, anticoagulation use emerged as an independent predictor of survival, as did sinus rhythm; however, the latter was offset by an increased mortality that was associated with antiarrhythmic drug and digoxin use [9]. Even with the use of potent antiarrhythmic drugs and an aggressive serial cardioversion strategy for early relapse, only 53% of patients remain in sinus rhythm after 1 year; at 5 years the figures are dire, with only 25% remaining free of AF [10,11]. Of note is the fact that many recurrences of AF occur asymptomatically.…”

Is rate more important than rhythm in treating atrial fibrillation? No

“…Repeated early external cardioversion is a quick and effective method of restoring sinus rhythm, particularly in patients taking anticoagulants who have relatively infrequent episodes of persistent atrial fibrillation. 20 Most cardiac centres are now offering left atrial ablation for patients with recurrent atrial fibrillation. Radiofrequency ablation reduces recurrences by about 65% at one year compared with drugs 21 and has been shown to improve cardiac function, 22 patient outcomes, 23 and quality of life.…”