title: Effectiveness and costs of chemical versus electrical cardioversion of atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation is the most common sustained cardiac arrhythmia and has an important impact on costs of medical assistance. Traditional interventions to convert atrial fibrillation to sinus rhythm are antiarrhythmic drugs and external electrical cardioversion. However, the best option for starting the cardioversion is not well established.
  
  
  METHODS
  In a multicentre randomised trial of 139 patients with persistent atrial fibrillation lasting less than 6 months, we compared the effectiveness and the cost-effectiveness ratio of initial treatment with chemical or electrical cardioversion. Subjects who did not achieve sinus rhythm with chemical cardioversion were considered to undergo electrical cardioversion and vice-versa.
  
  
  RESULTS
  The efficacy of the initial attempt for cardioversion was similar with chemical or electrical cardioversion (74 vs. 73%, P=0.95). However, the strategy of starting with antiarrhythmic drugs was more effective than with electrical procedure (96 vs. 84%, P=0.0016). Initiating with chemical cardioversion was also less expensive than with electrical cardioversion (1240 US dollars vs. 1917 US dollars ; P=0.002). Life-threatening complications occurred only during chemical cardioversion (5%), all of them in patients with structural heart disease.
  
  
  CONCLUSIONS
  In patients with persistent atrial fibrillation of less than 6 months, initial chemical or electrical cardioversion appear to be similar but the strategy of starting the cardioversion with antiarrhythmic drugs is more effective and less expensive than starting with the electrical procedure. Patients with structural heart disease undergoing chemical cardioversion seem to be more susceptible to severe complications.
authors.affiliation: Clinical Cardiac Electrophysiology, Paulista School of Medicine, Federal University of Sao Paulo, Rua Napoleão de Barros 593, ZIP 04024-002, São Paulo, Brazil. depaola@uol.com.br
authors.forename: Angelo A V
authors.initials: AA
authors.lastname: de Paola
authors.forename: Edilberto
authors.initials: E
authors.lastname: Figueiredo
authors.forename: Ricardo
authors.initials: R
authors.lastname: Sesso
authors.forename: Henrique H
authors.initials: HH
authors.lastname: Veloso
authors.forename: Luiz Olympio T
authors.initials: LO
authors.lastname: Nascimento
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D003362:Cost-Benefit Analysis / Q000191:economics*; D004554:Electric Countershock / Q000009:adverse effects / Q000191:economics*; D004562:Electrocardiography; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents