Electrical cardioversion for atrial fibrillation and flutter.
BACKGROUND
Atrial fibrillation increases the risk of stroke, increases the risk of cognitive impairment, and adversely affects cardiovascular haemodynamics. Electrical cardioversion for atrial fibrillation has been in use since the 1960s; the rationale is that restoration of sinus rhythm improves cardiovascular haemodynamics, reduces the risk of stroke, and obviates the need for long-term anticoagulation.


OBJECTIVE
To assess the effects of electrical cardioversion of atrial fibrillation or atrial flutter on the annual risk of thromboembolic events, strokes and mortality (primary outcomes measures), the rate of cognitive decline, quality of life, the use of anticoagulants and the risk of re-hospitalisation (secondary outcome measures) in adults (>18 years) with acute, paroxysmal or sustained atrial fibrillation or atrial flutter, of any duration and any aetiology.


METHODS
One reviewer searched the Cochrane Controlled Clinical Trials Register (2000 Issue 4), MEDLINE (1966 to December 2000), EMBASE (1980 to December 2000), CINAHL (1982 to November 2000) and proceedings of the American College of Cardiology (published in the Journal of the American College of Cardiology 1983 to 2000). Reference lists of articles were searched. Personal contact was made with experts in the field. A second reviewer handsearched proceedings of the British Cardiac Society (published in British Heart Journal (1980 to 1995) and in Heart (1995 to May 2001); proceedings of the European Congress of Cardiology and meetings of the Joint Working Groups of the European Society of Cardiology (published in European Heart Journal 1983-2000); scientific sessions of the American Heart Association (published in Circulation 1990-2000).


METHODS
Randomised controlled trial or controlled clinical trials of electrical cardioversion plus 'usual care' versus 'usual care' only, where 'usual care' included any combination of the following: anticoagulants, antiplatelet drugs and drugs for 'rate control', in adults (>18 years) with acute, paroxysmal or sustained atrial fibrillation or atrial flutter, of any duration and any aetiology.


METHODS
It was planned to extract study data onto data extraction forms. The planned analysis was by the statistical package in RevMan.


RESULTS
No completed randomised trials or controlled clinical trials of electrical cardioversion were found. Two ongoing trials were identified.


CONCLUSIONS
There were no data from completed randomised controlled trials or controlled clinical trials to either support or refute the use of electrical cardioversion for atrial fibrillation. Randomised trials of electrical cardioversion are required.
Mead
G E
GE
Clinical and Surgical Sciences, University of Edinburgh, 21 Chalmers Street, Edinburgh, UK, EH3 9EW. gmead@srv1.med.ed.ac.uk
Flapan
A D
AD
Elder
A T
AT
D000328:Adult; D001281:Atrial Fibrillation / Q000628:therapy*; D001282:Atrial Flutter / Q000628:therapy*; D004554:Electric Countershock / Q000379:methods*; D006801:Humans