PMID: 11899578Mar 20, 2002Paper

Atrial fibrillation: always cardioversion? No

Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology
Giuseppe Di PasqualeLeonardo G Pancaldi

Abstract

Two major treatment strategies have emerged in the management of patients with atrial fibrillation (AF): restoration of sinus rhythm and antiarrhythmic drug prophylaxis versus ventricular rate control and chronic anticoagulation. Besides the potential benefits of the restoration of sinus rhythm, several considerations support the choice of controlling the heart rate, mainly the poor efficacy of antiarrhythmic drug prophylaxis. The decision of pursuing the AF cardioversion should be based mainly on the importance of sinus rhythm restoration and the probability of sinus rhythm maintenance. The factors conditioning the maintenance of sinus rhythm following cardioversion are the duration of AF, cardiac size and function, underlying heart disease, the NYHA functional class, and the timing and number of AF recurrences. At least one attempt at cardioversion is warranted in the majority of patients with a first ever episode of AF; however, it seems advisable to give up even the first attempt at cardioversion in the mildly symptomatic patients who are very old, in patients with AF episodes dating back more than 24-36 months and in those with severe valvular heart disease or severe left ventricular dysfunction. A repeated attempt at card...Continue Reading

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